Provider Demographics
NPI:1053198200
Name:KAMEL, MIRETTE
Entity type:Individual
Prefix:
First Name:MIRETTE
Middle Name:
Last Name:KAMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 N MAIN ST UNIT 104
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3483
Mailing Address - Country:US
Mailing Address - Phone:508-361-3731
Mailing Address - Fax:
Practice Address - Street 1:84 N MAIN ST UNIT 104
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3483
Practice Address - Country:US
Practice Address - Phone:508-361-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH996899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist