Healthcare Provider Details

I. General information

NPI: 1538712252
Provider Name (Legal Business Name): NIKITA ZININ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 COMMONWEALTH AVE
ALLSTON MA
02134-3301
US

IV. Provider business mailing address

1006 PARADISE PHR
SWAMPSCOTT MA
01907
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-5900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH237897
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: