Provider Demographics
NPI:1801491626
Name:HAJAGHAIE, MARYAM LAILA
Entity type:Individual
Prefix:MS
First Name:MARYAM
Middle Name:LAILA
Last Name:HAJAGHAIE
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 1:6724 CROOKED PALM TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2918
Mailing Address - Country:US
Mailing Address - Phone:305-820-2122
Mailing Address - Fax:305-820-6838
Practice Address - Street 1:6724 CROOKED PALM TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2918
Practice Address - Country:US
Practice Address - Phone:305-820-2122
Practice Address - Fax:305-820-6838
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist