Provider Demographics
NPI:1679242267
Name:TAGHAVI BAYAT, ZAHRA
Entity Type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:TAGHAVI BAYAT
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 1:194 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4394
Mailing Address - Country:US
Mailing Address - Phone:973-429-0444
Mailing Address - Fax:
Practice Address - Street 1:194 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4394
Practice Address - Country:US
Practice Address - Phone:973-429-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R104113500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist