Provider Demographics
NPI:1679859052
Name:NAZARIAN, JONATHAN (PHARM D)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:NAZARIAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9060 KIMBERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2842
Mailing Address - Country:US
Mailing Address - Phone:561-451-1448
Mailing Address - Fax:
Practice Address - Street 1:9060 KIMBERLY BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2842
Practice Address - Country:US
Practice Address - Phone:561-451-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist