Provider Demographics
NPI:1982216784
Name:MIRZA, ANUM
Entity Type:Individual
Prefix:
First Name:ANUM
Middle Name:
Last Name:MIRZA
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 1:392 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:392 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1822
Practice Address - Country:US
Practice Address - Phone:781-447-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist