Provider Demographics
NPI:1932576568
Name:HYSENAJ, MIMOZA (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:MIMOZA
Middle Name:
Last Name:HYSENAJ
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2538
Mailing Address - Country:US
Mailing Address - Phone:781-581-1681
Mailing Address - Fax:
Practice Address - Street 1:52 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2538
Practice Address - Country:US
Practice Address - Phone:781-581-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist