Provider Demographics
NPI:1811587629
Name:RAMACHANDRAN, ROBY
Entity Type:Individual
Prefix:MR
First Name:ROBY
Middle Name:
Last Name:RAMACHANDRAN
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 1:250 ROSLINDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3303
Mailing Address - Country:US
Mailing Address - Phone:617-459-2613
Mailing Address - Fax:
Practice Address - Street 1:467 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2020
Practice Address - Country:US
Practice Address - Phone:617-522-8062
Practice Address - Fax:617-522-7951
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2070Medicaid