Provider Demographics
NPI:1003101155
Name:AGHA, CHIRINE M (RPH)
Entity Type:Individual
Prefix:
First Name:CHIRINE
Middle Name:M
Last Name:AGHA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 OLENTANGY RIVER RD
Mailing Address - Street 2:T-1058
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1452
Mailing Address - Country:US
Mailing Address - Phone:614-298-1078
Mailing Address - Fax:
Practice Address - Street 1:1717 OLENTANGY RIVER RD
Practice Address - Street 2:T-1058
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1452
Practice Address - Country:US
Practice Address - Phone:614-298-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03321555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist