Provider Demographics
NPI:1780408989
Name:HASSAN, MAYA AIMAN
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:AIMAN
Last Name:HASSAN
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 1:272 JADIS CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-0044
Mailing Address - Country:US
Mailing Address - Phone:260-414-8155
Mailing Address - Fax:
Practice Address - Street 1:115 STATE ROAD 930 E
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1359
Practice Address - Country:US
Practice Address - Phone:260-493-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030674A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist