Individual provider Active NPI

Farnaz Rahmanou Tavakoli, RPH

  • Pharmacist
  • Mineola, NY
National Provider Identifier
1578743480
Registry record updated Nov 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
043000 Issued in NY
Practice address
52 Jericho Tpke
Mineola, NY 11501-2930
Phone
(516) 873-2020
Fax
(516) 873-2028
NPI assigned
Nov 7, 2007
Last updated
Nov 7, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 043000 NY Primary

Addresses

Primary practice location

52 Jericho Tpke
Mineola, NY 11501-2930

Mailing address

19 Beverly Rd
Great Neck, NY 11021-1322
Phone (516) 773-3425

Other identifiers 1

IdentifierTypeStateIssuer
01549499MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
043000NYMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194393600000",
    "number": "1578743480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BEVERLY RD",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110211322",
            "telephone_number": "516-773-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 JERICHO TPKE",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115012930",
            "telephone_number": "516-873-2020",
            "fax_number": "516-873-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVAKOLI",
        "first_name": "FARNAZ",
        "middle_name": "RAHMANOU",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "043000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01549499",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.