Provider Demographics
NPI:1417499476
Name:MBAKOP, ULRICH L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ULRICH
Middle Name:L
Last Name:MBAKOP
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 1:225 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7303
Mailing Address - Country:US
Mailing Address - Phone:508-397-2568
Mailing Address - Fax:
Practice Address - Street 1:225 IRVING ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7303
Practice Address - Country:US
Practice Address - Phone:508-397-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist