MEDICARE: DR. JAMES MICHAEL GAGNON JR. PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	MA25437	MA

General Provider Information

NPI Number	:	1689676389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL GAGNON JR. PHARM.D.

Provider Business Mailing Address
First Line	:	3 NEWELL RD
Second Line	:
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-2613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5804
Country	:	US
Telephone Number	:	617-732-2068
Fax Number	:	617-732-2244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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