Provider Demographics
NPI:1174320980
Name:RAZACK, JAVID
Entity type:Individual
Prefix:
First Name:JAVID
Middle Name:
Last Name:RAZACK
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 1:338 CHEYENNE FLS
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2600
Mailing Address - Country:US
Mailing Address - Phone:440-315-1158
Mailing Address - Fax:
Practice Address - Street 1:20200 VAN AKEN BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-3623
Practice Address - Country:US
Practice Address - Phone:216-751-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03445118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist