Provider Demographics
NPI:1851021166
Name:ISMAIL, ADEN HAZIM (RPH)
Entity type:Individual
Prefix:
First Name:ADEN
Middle Name:HAZIM
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-1310
Mailing Address - Country:US
Mailing Address - Phone:413-504-3729
Mailing Address - Fax:
Practice Address - Street 1:1440 BOSTON RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129-1128
Practice Address - Country:US
Practice Address - Phone:413-543-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist