Provider Demographics
NPI:1467154690
Name:DECHKOUNIAN, ROUPEN
Entity Type:Individual
Prefix:
First Name:ROUPEN
Middle Name:
Last Name:DECHKOUNIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8118
Mailing Address - Country:US
Mailing Address - Phone:617-633-0794
Mailing Address - Fax:
Practice Address - Street 1:181 CEDAR HILL ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3057
Practice Address - Country:US
Practice Address - Phone:508-624-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038076183500000X
MAPH27354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist