Healthcare Provider Details

I. General information

NPI: 1750647137
Provider Name (Legal Business Name): KULSOOM N AHMED-KAGZI R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIRNIE AVE
SPRINGFIELD MA
01107-1107
US

IV. Provider business mailing address

300 BIRNIE AVE
SPRINGFIELD MA
01107-1107
US

V. Phone/Fax

Practice location:
  • Phone: 413-736-5649
  • Fax: 413-736-5099
Mailing address:
  • Phone: 413-736-5649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24074
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: