Provider Demographics
NPI:1659198018
Name:KHAZENDAR, ABRAHIM
Entity type:Individual
Prefix:DR
First Name:ABRAHIM
Middle Name:
Last Name:KHAZENDAR
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 1:5612 ARBORVISTA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9312
Mailing Address - Country:US
Mailing Address - Phone:256-289-0427
Mailing Address - Fax:
Practice Address - Street 1:7243 DELLA DR STE F
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5106
Practice Address - Country:US
Practice Address - Phone:321-842-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist