Provider Demographics
NPI:1679946560
Name:RAZEQ, RIFAT
Entity type:Individual
Prefix:
First Name:RIFAT
Middle Name:
Last Name:RAZEQ
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 1:316 MONTGOMERY AVE APT B
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4234
Mailing Address - Country:US
Mailing Address - Phone:215-651-1776
Mailing Address - Fax:
Practice Address - Street 1:316 MONTGOMERY AVE APT B
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-4234
Practice Address - Country:US
Practice Address - Phone:215-651-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist