Provider Demographics
NPI:1275279564
Name:MUNYABURANGA NYEMBO, ROGER
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MUNYABURANGA NYEMBO
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 1:1 KIMBALL CT APT 101
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6409
Mailing Address - Country:US
Mailing Address - Phone:424-221-0291
Mailing Address - Fax:
Practice Address - Street 1:350 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6037
Practice Address - Country:US
Practice Address - Phone:781-933-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist