Provider Demographics
NPI:1407138738
Name:KOUYOUMJIAN, KEVORK (PHARM D)
Entity Type:Individual
Prefix:
First Name:KEVORK
Middle Name:
Last Name:KOUYOUMJIAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-8107
Mailing Address - Country:US
Mailing Address - Phone:617-460-5289
Mailing Address - Fax:
Practice Address - Street 1:324 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8306
Practice Address - Country:US
Practice Address - Phone:781-643-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist