Provider Demographics
NPI:1396522108
Name:REZAEI, FATEMEHALSADAT
Entity type:Individual
Prefix:DR
First Name:FATEMEHALSADAT
Middle Name:
Last Name:REZAEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MANOR DR APT 211
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2626
Mailing Address - Country:US
Mailing Address - Phone:773-441-5403
Mailing Address - Fax:
Practice Address - Street 1:199 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1211
Practice Address - Country:US
Practice Address - Phone:859-873-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH88302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist