Provider Demographics
NPI:1497039242
Name:RAZA, RANA S
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:S
Last Name:RAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4297 OLDFIELD CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7866
Mailing Address - Country:US
Mailing Address - Phone:904-288-0652
Mailing Address - Fax:904-288-0712
Practice Address - Street 1:4297 OLDFIELD CROSSING DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7866
Practice Address - Country:US
Practice Address - Phone:904-288-0652
Practice Address - Fax:904-288-0712
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106228000Medicaid