Healthcare Provider Details

I. General information

NPI: 1093217549
Provider Name (Legal Business Name): ELIZABETH JUDE HAFTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S BEDFORD ST
BURLINGTON MA
01803-5108
US

IV. Provider business mailing address

111 GRANITE ST
MALDEN MA
02148
US

V. Phone/Fax

Practice location:
  • Phone: 603-930-4268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH2234988
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: