Healthcare Provider Details

I. General information

NPI: 1427981489
Provider Name (Legal Business Name): MAYGYUL IZZATOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 MEMORIAL DR
CHICOPEE MA
01020-3933
US

IV. Provider business mailing address

PO BOX 224
WEST SPRINGFIELD MA
01090-0224
US

V. Phone/Fax

Practice location:
  • Phone: 413-532-3299
  • Fax:
Mailing address:
  • Phone: 413-627-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1002180
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: