Provider Demographics
NPI:1477135929
Name:ALBAYATI, IMAN A
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:A
Last Name:ALBAYATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5014
Mailing Address - Country:US
Mailing Address - Phone:978-681-0409
Mailing Address - Fax:
Practice Address - Street 1:494 HOWE ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1208
Practice Address - Country:US
Practice Address - Phone:978-905-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist