Healthcare Provider Details

I. General information

NPI: 1659657807
Provider Name (Legal Business Name): SAIDEH KHAVANDEGARAN THAW RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N COMMERCE PKWY
MIRAMAR FL
33025-3959
US

IV. Provider business mailing address

17721 SW 7TH ST
PEMBROKE PINES FL
33029-4209
US

V. Phone/Fax

Practice location:
  • Phone: 786-362-8253
  • Fax: 954-985-8238
Mailing address:
  • Phone: 954-319-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: