Provider Demographics
NPI:1891064465
Name:REZAI, FARAMARZ
Entity Type:Individual
Prefix:DR
First Name:FARAMARZ
Middle Name:
Last Name:REZAI
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 1:2200 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4401
Mailing Address - Country:US
Mailing Address - Phone:239-263-0240
Mailing Address - Fax:
Practice Address - Street 1:2200 9TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4401
Practice Address - Country:US
Practice Address - Phone:239-263-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44723183500000X
NJ28RI03077200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist