Provider Demographics
NPI:1215475421
Name:LAVASANIFAR, HENGAMEH (PHARMD)
Entity type:Individual
Prefix:
First Name:HENGAMEH
Middle Name:
Last Name:LAVASANIFAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JCB;131 ORNAC SUITE 200;
Mailing Address - Street 2:MGH CANCER CENTER AT EMERSON HOSPITAL
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-371-4845
Mailing Address - Fax:
Practice Address - Street 1:JCB;131 ORNAC SUITE 200;
Practice Address - Street 2:MGH CANCER CENTER AT EMERSON HOSPITAL
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-371-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH25320OtherPHARMACIST LICENSE NUMBER