Provider Demographics
NPI:1447343553
Name:FOURNIER, VICTOR PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:PAUL
Last Name:FOURNIER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 BEACON ST
Mailing Address - Street 2:APT A
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5212
Mailing Address - Country:US
Mailing Address - Phone:781-738-1115
Mailing Address - Fax:
Practice Address - Street 1:50 TREMONT ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2721
Practice Address - Country:US
Practice Address - Phone:781-738-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist