Healthcare Provider Details

I. General information

NPI: 1346654621
Provider Name (Legal Business Name): IRA XHAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 CHANDLER ST
WORCESTER MA
01602-3329
US

IV. Provider business mailing address

9 KIMBALL ST
WORCESTER MA
01605-3110
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-5348
  • Fax:
Mailing address:
  • Phone: 508-754-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH233570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: