Provider Demographics
NPI:1427424746
Name:KHORASANI, ALI NOURI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:NOURI
Last Name:KHORASANI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 3RD AVE APT 8G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3050
Mailing Address - Country:US
Mailing Address - Phone:949-331-4415
Mailing Address - Fax:
Practice Address - Street 1:131 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5102
Practice Address - Country:US
Practice Address - Phone:212-929-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist