Provider Demographics
NPI:1003180787
Name:KVILHAUG, MAGNAR (RPH)
Entity Type:Individual
Prefix:
First Name:MAGNAR
Middle Name:
Last Name:KVILHAUG
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 1:17 W HILL RD
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1836
Mailing Address - Country:US
Mailing Address - Phone:508-965-7988
Mailing Address - Fax:
Practice Address - Street 1:17 W HILL RD
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1836
Practice Address - Country:US
Practice Address - Phone:508-965-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH19626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist