Provider Demographics
NPI:1508110792
Name:KAZEROONI, REZA (PHARMD, BCPS, BCOP)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:KAZEROONI
Suffix:
Gender:M
Credentials:PHARMD, BCPS, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6334 MYSTIC BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2259
Mailing Address - Country:US
Mailing Address - Phone:713-206-6169
Mailing Address - Fax:
Practice Address - Street 1:6334 MYSTIC BRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2259
Practice Address - Country:US
Practice Address - Phone:713-206-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43052183500000X, 1835P1200X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835X0200XPharmacy Service ProvidersPharmacistOncology