Provider Demographics
NPI:1528236585
Name:YAZDANIE, NAILA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:NAILA
Middle Name:
Last Name:YAZDANIE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8502
Mailing Address - Country:US
Mailing Address - Phone:631-486-8740
Mailing Address - Fax:631-486-8482
Practice Address - Street 1:480 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8502
Practice Address - Country:US
Practice Address - Phone:631-486-8740
Practice Address - Fax:631-486-8482
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist