Healthcare Provider Details

I. General information

NPI: 1336744366
Provider Name (Legal Business Name): KANELLA HATZIS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DODGE ST
BEVERLY MA
01915-1705
US

IV. Provider business mailing address

26 MARILYN CT
LYNN MA
01904-2056
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-0060
  • Fax:
Mailing address:
  • Phone: 339-206-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number233347
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: