Provider Demographics
NPI:1619250164
Name:AZARM, BAHMAN
Entity Type:Individual
Prefix:MR
First Name:BAHMAN
Middle Name:
Last Name:AZARM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-1700
Mailing Address - Country:US
Mailing Address - Phone:305-373-4320
Mailing Address - Fax:305-373-9318
Practice Address - Street 1:1 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1700
Practice Address - Country:US
Practice Address - Phone:305-373-4320
Practice Address - Fax:305-373-9318
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist