MEDICARE: IDA DAVOODI

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	RPH84239	CA
2	183500000X	Pharmacist	PS64724	FL

General Provider Information

NPI Number	:	1841907797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDA DAVOODI

Provider Business Mailing Address
First Line	:	6982 LAKE NONA BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7769
Country	:	US
Telephone Number	:	916-990-3715
Fax Number	:

Provider Business Practice Location Address
First Line	:	6982 LAKE NONA BLVD APT 308
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7897
Country	:	US
Telephone Number	:	916-990-3715
Fax Number	:

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

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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Directions to “ IDA DAVOODI ” Practice Location

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