Provider Demographics
NPI:1841945516
Name:KABUTHIA, COLLINS EVANS
Entity type:Individual
Prefix:
First Name:COLLINS
Middle Name:EVANS
Last Name:KABUTHIA
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 1:14 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5014
Mailing Address - Country:US
Mailing Address - Phone:978-681-7607
Mailing Address - Fax:
Practice Address - Street 1:14 JACKSON ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5014
Practice Address - Country:US
Practice Address - Phone:978-681-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist