Healthcare Provider Details

I. General information

NPI: 1346150513
Provider Name (Legal Business Name): LIDA KHOSHNIAT-RAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1080 NW 11TH ST APT C305
MIAMI FL
33136-2200
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-4064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: