Healthcare Provider Details

I. General information

NPI: 1538023221
Provider Name (Legal Business Name): AMNAH ABDULRHMAN M. ABDULHAQ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 LEBANON ST
MELROSE MA
02176-3225
US

IV. Provider business mailing address

501 VFW PKWY
CHESTNUT HILL MA
02467-3637
US

V. Phone/Fax

Practice location:
  • Phone: 617-901-7607
  • Fax:
Mailing address:
  • Phone: 617-901-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1000925
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: