Provider Demographics
NPI:1629350350
Name:KYOMITMAITEE, EMILY (PHARMD, RPH)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:KYOMITMAITEE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2121
Mailing Address - Country:US
Mailing Address - Phone:978-794-8130
Mailing Address - Fax:978-794-8703
Practice Address - Street 1:220 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2121
Practice Address - Country:US
Practice Address - Phone:978-794-8130
Practice Address - Fax:978-794-8703
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist