Healthcare Provider Details

I. General information

NPI: 1396702171
Provider Name (Legal Business Name): MICHAEL DILALLA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD PHARMACY SERVICE (119)
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

PO BOX 858
NORWOOD MA
02062-0858
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2325
  • Fax:
Mailing address:
  • Phone: 781-687-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20564
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: