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General NPI Number Information
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NPI Number | 1780408989
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Entity Type | Individual
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Provider Name | MAYA AIMAN HASSAN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 115 STATE ROAD 930 E
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City | NEW HAVEN
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State | IN
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Zip | 46774-1359
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Country | US
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Telephone | 260-493-1514
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Fax |
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Provider Business Mailing Address
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Address Line | 272 JADIS CT
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City | FORT WAYNE
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State | IN
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Zip | 46845-0044
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Country | US
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Telephone | 260-414-8155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26030674A
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License Number State | IN
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