Provider Demographics
NPI:1194246249
Name:TIWARI, AMANDA (MPHARM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TIWARI
Suffix:
Gender:F
Credentials:MPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WEXFORD ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2912
Mailing Address - Country:US
Mailing Address - Phone:888-633-6463
Mailing Address - Fax:844-633-6463
Practice Address - Street 1:30 WEXFORD ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2912
Practice Address - Country:US
Practice Address - Phone:888-633-6463
Practice Address - Fax:844-633-6463
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68248183500000X
MAPH237115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist