Provider Demographics
NPI:1659657807
Name:THAW, SAIDEH KHAVANDEGARAN (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAIDEH
Middle Name:KHAVANDEGARAN
Last Name:THAW
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17721 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-4209
Mailing Address - Country:US
Mailing Address - Phone:954-319-3197
Mailing Address - Fax:
Practice Address - Street 1:2900 N COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3959
Practice Address - Country:US
Practice Address - Phone:786-362-8253
Practice Address - Fax:954-985-8238
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist