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General NPI Number Information
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NPI Number | 1578743480
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Entity Type | Individual
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Provider Name | FARNAZ RAHMANOU TAVAKOLI RPH
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Gender | Female
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 52 JERICHO TPKE
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City | MINEOLA
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State | NY
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Zip | 11501-2930
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Country | US
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Telephone | 516-873-2020
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Fax | 516-873-2028
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Provider Business Mailing Address
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Address Line | 19 BEVERLY RD
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City | GREAT NECK
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State | NY
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Zip | 11021-1322
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Country | US
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Telephone | 516-773-3425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 043000
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License Number State | NY
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