Provider Demographics
NPI:1487835948
Name:ANAIZI, NASR H (PHD, RPH)
Entity Type:Individual
Prefix:DR
First Name:NASR
Middle Name:H
Last Name:ANAIZI
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2237
Mailing Address - Country:US
Mailing Address - Phone:585-264-0799
Mailing Address - Fax:
Practice Address - Street 1:19 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2237
Practice Address - Country:US
Practice Address - Phone:585-264-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02519359Medicaid