Provider Demographics
NPI:1982373171
Name:NIAKI, NOJAN NASSERI
Entity type:Individual
Prefix:
First Name:NOJAN
Middle Name:NASSERI
Last Name:NIAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CARRIAGE HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1358
Mailing Address - Country:US
Mailing Address - Phone:150-898-5326
Mailing Address - Fax:
Practice Address - Street 1:11 PEARL ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6519
Practice Address - Country:US
Practice Address - Phone:781-356-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist