Provider Demographics
NPI:1962284612
Name:ADELI, FARANAK
Entity type:Individual
Prefix:
First Name:FARANAK
Middle Name:
Last Name:ADELI
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 1:10908 BALANTRE LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1321
Mailing Address - Country:US
Mailing Address - Phone:240-472-1109
Mailing Address - Fax:
Practice Address - Street 1:701 CRESTDALE RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1700
Practice Address - Country:US
Practice Address - Phone:800-432-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist