Provider Demographics
NPI:1114997632
Name:KEOMURJIAN, ALINE S (PHARMD, CDM)
Entity Type:Individual
Prefix:DR
First Name:ALINE
Middle Name:S
Last Name:KEOMURJIAN
Suffix:
Gender:F
Credentials:PHARMD, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-7206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-7206
Practice Address - Country:US
Practice Address - Phone:781-899-3332
Practice Address - Fax:781-899-2189
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist