Healthcare Provider Details

I. General information

NPI: 1376117507
Provider Name (Legal Business Name): MINA ALBAYATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 EAST SILVER ST
WESTFIELD MA
01085
US

IV. Provider business mailing address

104 WHEATLAND AVE
CHICOPEE MA
01020
US

V. Phone/Fax

Practice location:
  • Phone: 413-568-5116
  • Fax:
Mailing address:
  • Phone: 413-885-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH239698
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: