Provider Demographics
NPI:1558534461
Name:RAMEZANZADEH, PARVANEH MOSLEMI (CM, PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:PARVANEH
Middle Name:MOSLEMI
Last Name:RAMEZANZADEH
Suffix:
Gender:F
Credentials:CM, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5645
Mailing Address - Country:US
Mailing Address - Phone:973-941-8420
Mailing Address - Fax:
Practice Address - Street 1:230 VAN WINKLE AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110
Practice Address - Country:US
Practice Address - Phone:973-667-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MM00000800176B00000X
NJ28RI03976500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No176B00000XOther Service ProvidersMidwife