Healthcare Provider Details

I. General information

NPI: 1891064465
Provider Name (Legal Business Name): DR. FARAMARZ REZAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 9TH ST N
NAPLES FL
34103-4401
US

IV. Provider business mailing address

2200 9TH ST N
NAPLES FL
34103-4401
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-0240
  • Fax:
Mailing address:
  • Phone: 239-263-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44723
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03077200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: