Provider Demographics
NPI:1710691480
Name:SMADI, LIDA
Entity Type:Individual
Prefix:
First Name:LIDA
Middle Name:
Last Name:SMADI
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 1:859 BROADWAY APT 419
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3396
Mailing Address - Country:US
Mailing Address - Phone:857-544-6781
Mailing Address - Fax:
Practice Address - Street 1:166 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-1994
Practice Address - Country:US
Practice Address - Phone:617-367-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist