Provider Demographics
NPI:1669459038
Name:MOURA, ROBERT JAMES (MS, RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:MOURA
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DOROTHY RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8859
Mailing Address - Country:US
Mailing Address - Phone:978-287-3771
Mailing Address - Fax:978-287-3670
Practice Address - Street 1:133 OLD ROAD TO NAC
Practice Address - Street 2:EMERSON HOSPITAL PHARMACY DEPT.
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4159
Practice Address - Country:US
Practice Address - Phone:978-287-3771
Practice Address - Fax:978-287-3670
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist