Provider Demographics
NPI:1770924839
Name:REZAEI, FARID (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:REZAEI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 I-45 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340
Mailing Address - Country:US
Mailing Address - Phone:936-296-3041
Mailing Address - Fax:936-295-6815
Practice Address - Street 1:11711 MEMORIAL DR
Practice Address - Street 2:505
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-7255
Practice Address - Country:US
Practice Address - Phone:936-296-3041
Practice Address - Fax:936-295-6815
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist