MEDICARE: MASOUD MORADI RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	046859	NY

General Provider Information

NPI Number	:	1346500428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASOUD MORADI RPH

Provider Business Mailing Address
First Line	:	1 APPLETREE LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1925
Country	:	US
Telephone Number	:	516-343-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 APPLETREE LN
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1925
Country	:	US
Telephone Number	:	516-343-2233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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Directions to “ MASOUD MORADI RPH” Practice Location

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