Provider Demographics
NPI:1265572739
Name:IMAM, KAZI H (RPH)
Entity type:Individual
Prefix:
First Name:KAZI
Middle Name:H
Last Name:IMAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 CYPRESS LAKES PRESERVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-4627
Mailing Address - Country:US
Mailing Address - Phone:561-249-9886
Mailing Address - Fax:
Practice Address - Street 1:12425 HAGEN RANCH RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4107
Practice Address - Country:US
Practice Address - Phone:561-292-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37202183500000X
TX52617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist