Provider Demographics
NPI:1760704076
Name:YAZEHMIDI, BANAFSHEH (RPH)
Entity Type:Individual
Prefix:
First Name:BANAFSHEH
Middle Name:
Last Name:YAZEHMIDI
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 1:14360 243RD ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2340
Mailing Address - Country:US
Mailing Address - Phone:718-276-0274
Mailing Address - Fax:
Practice Address - Street 1:14360 243RD ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2340
Practice Address - Country:US
Practice Address - Phone:718-276-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI 053958-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist