Healthcare Provider Details

I. General information

NPI: 1184347692
Provider Name (Legal Business Name): TRICIA FAJE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HARVARD AVE
ALLSTON MA
02134-4619
US

IV. Provider business mailing address

214 HARVARD AVE
ALLSTON MA
02134-4619
US

V. Phone/Fax

Practice location:
  • Phone: 617-277-6080
  • Fax: 617-277-4951
Mailing address:
  • Phone: 617-277-6080
  • Fax: 617-277-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH240643
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: