Healthcare Provider Details

I. General information

NPI: 1710697081
Provider Name (Legal Business Name): RANDA HADAYIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MAIN ST
MAYNARD MA
01754-2514
US

IV. Provider business mailing address

183 WASHINGTON ST APT 1
WESTWOOD MA
02090-1329
US

V. Phone/Fax

Practice location:
  • Phone: 978-897-2939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26357
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: