Provider Demographics
NPI:1982207098
Name:HAJNASR, HEATHER LYN
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYN
Last Name:HAJNASR
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 1:133 BARNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1790
Mailing Address - Country:US
Mailing Address - Phone:508-472-0364
Mailing Address - Fax:
Practice Address - Street 1:2253 STATE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5150
Practice Address - Country:US
Practice Address - Phone:508-833-3875
Practice Address - Fax:508-833-6581
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist