Provider Demographics
NPI:1932480134
Name:BOUTROS, AMANI (RPH)
Entity Type:Individual
Prefix:MS
First Name:AMANI
Middle Name:
Last Name:BOUTROS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 PURDUE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1243
Mailing Address - Country:US
Mailing Address - Phone:508-380-7078
Mailing Address - Fax:
Practice Address - Street 1:20 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1688
Practice Address - Country:US
Practice Address - Phone:508-966-1691
Practice Address - Fax:508-966-1697
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist