MEDICARE: MS. MARYAM LAILA HAJAGHAIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS56916	FL

General Provider Information

NPI Number	:	1801491626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARYAM LAILA HAJAGHAIE

Provider Business Mailing Address
First Line	:	6724 CROOKED PALM TER
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2918
Country	:	US
Telephone Number	:	305-820-2122
Fax Number	:	305-820-6838

Provider Business Practice Location Address
First Line	:	6724 CROOKED PALM TER
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2918
Country	:	US
Telephone Number	:	305-820-2122
Fax Number	:	305-820-6838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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