Provider Demographics
NPI:1740718444
Name:GHAZVINI, KAMYAR
Entity type:Individual
Prefix:MR
First Name:KAMYAR
Middle Name:
Last Name:GHAZVINI
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 1:2050 E ALGONQUIN RD STE 606
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4161
Mailing Address - Country:US
Mailing Address - Phone:847-469-2400
Mailing Address - Fax:847-469-2401
Practice Address - Street 1:2050 E ALGONQUIN RD STE 606
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4161
Practice Address - Country:US
Practice Address - Phone:847-469-2400
Practice Address - Fax:847-469-2401
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist