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General NPI Number Information
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NPI Number | 1942541818
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Entity Type | Individual
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Provider Name | POUYA K RAD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 100 E LANCASTER AVE
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3450
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Country | US
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Telephone | 484-476-2041
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Fax |
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Provider Business Mailing Address
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Address Line | 39 RAMSGATE CT
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City | BLUE BELL
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State | PA
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Zip | 19422-2547
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Country | US
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Telephone | 267-283-6087
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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 | RP442818
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | R2207
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | R2207
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RP442818
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License Number State | PA
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