Provider Demographics
NPI:1407094105
Name:NAJARIAN, KEITH A (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:A
Last Name:NAJARIAN
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 1:414 PARK AVE
Mailing Address - Street 2:PARK AVENUE PHARMACY
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1333
Mailing Address - Country:US
Mailing Address - Phone:508-890-8589
Mailing Address - Fax:
Practice Address - Street 1:414 PARK AVE
Practice Address - Street 2:PARK AVENUE PHARMACY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1333
Practice Address - Country:US
Practice Address - Phone:508-890-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist