Provider Demographics
NPI:1750821518
Name:POURNAZARI, PARDIS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PARDIS
Middle Name:
Last Name:POURNAZARI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PARSELLS CT
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2915
Mailing Address - Country:US
Mailing Address - Phone:917-547-9223
Mailing Address - Fax:201-567-1881
Practice Address - Street 1:48 UNION AVE
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2125
Practice Address - Country:US
Practice Address - Phone:201-567-2235
Practice Address - Fax:201-567-1881
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03712200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist