Provider Demographics
NPI:1427183896
Name:BALRAM, SWASNAND (RPH)
Entity Type:Individual
Prefix:MR
First Name:SWASNAND
Middle Name:
Last Name:BALRAM
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:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-0857
Mailing Address - Country:US
Mailing Address - Phone:617-429-6251
Mailing Address - Fax:
Practice Address - Street 1:7 HAVILAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-2683
Practice Address - Country:US
Practice Address - Phone:617-927-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA23205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist