Provider Demographics
NPI:1780937581
Name:AGHASILI, UGOOLISA AKUAMIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:UGOOLISA
Middle Name:AKUAMIA
Last Name:AGHASILI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:UGOOLISA
Other - Middle Name:AKUAMIA
Other - Last Name:AGHASILI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1250 FELLSWAY APT 3
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6330
Mailing Address - Country:US
Mailing Address - Phone:857-829-1456
Mailing Address - Fax:
Practice Address - Street 1:1250 FELLSWAY APT 3
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6330
Practice Address - Country:US
Practice Address - Phone:857-829-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist