Provider Demographics
NPI:1205670130
Name:BARGHUTHI, RAYA ISSAM
Entity type:Individual
Prefix:
First Name:RAYA
Middle Name:ISSAM
Last Name:BARGHUTHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1726
Mailing Address - Country:US
Mailing Address - Phone:857-319-0396
Mailing Address - Fax:
Practice Address - Street 1:16 BOSTON RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3013
Practice Address - Country:US
Practice Address - Phone:978-256-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1000486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist