=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326636747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEDA REZAEIAN PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2021
-----------------------------------------------------
Last Update Date | 01/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5405 LYNX LN
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21044-2374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-740-7273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 BAYRIDGE CT
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20878-1954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-449-0491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 24754
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------