=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114997632
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALINE S KEOMURJIAN PHARMD, CDM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2006
-----------------------------------------------------
Last Update Date | 11/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1070 LEXINGTON ST
-----------------------------------------------------
City | WALTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02452-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-899-3332
-----------------------------------------------------
Fax | 781-899-2189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1070 LEXINGTON ST
-----------------------------------------------------
City | WALTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02452-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 21549
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------