Provider Demographics
NPI:1215210588
Name:AGARWAL, ROMA V (01011968)
Entity Type:Individual
Prefix:
First Name:ROMA
Middle Name:V
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:01011968
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8513
Mailing Address - Country:US
Mailing Address - Phone:508-935-2203
Mailing Address - Fax:
Practice Address - Street 1:624 WAVERLY ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8513
Practice Address - Country:US
Practice Address - Phone:508-935-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist