Healthcare Provider Details

I. General information

NPI: 1295641462
Provider Name (Legal Business Name): HADI NIKOONEJAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 NW 13TH ST
GAINESVILLE FL
32609-3418
US

IV. Provider business mailing address

5066 NW 22ND ST
GAINESVILLE FL
32605-5474
US

V. Phone/Fax

Practice location:
  • Phone: 352-380-9039
  • Fax: 352-380-9101
Mailing address:
  • Phone: 352-804-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: