Provider Demographics
NPI:1467063412
Name:LATIFPOUR, ROUDABEH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROUDABEH
Middle Name:
Last Name:LATIFPOUR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4335
Mailing Address - Country:US
Mailing Address - Phone:617-327-9360
Mailing Address - Fax:
Practice Address - Street 1:75 SPRING ST
Practice Address - Street 2:75 SPRING ST., WEST ROXBURY, MA 02132
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132
Practice Address - Country:US
Practice Address - Phone:617-327-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0009316183500000X
MA27010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist