Basic Information
| Provider Information | |||||||||
| NPI: | 1770189854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAJJ | ||||||||
| FirstName: | ROLA | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2224 LAKE SYLVAN OAKS CT | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327716631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165487450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5650 RED BUG LAKE RD | ||||||||
| Address2: | |||||||||
| City: | WINTER SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327084904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076990781 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2020 | ||||||||
| LastUpdateDate: | 12/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS59140 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.