Provider Demographics
NPI:1215210356
Name:PANOYAN, PIERRE
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:
Last Name:PANOYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 TEMPLE RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-7828
Mailing Address - Country:US
Mailing Address - Phone:781-643-4112
Mailing Address - Fax:
Practice Address - Street 1:273 TEMPLE RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-7828
Practice Address - Country:US
Practice Address - Phone:781-643-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH22860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist