Healthcare Provider Details

I. General information

NPI: 1063016376
Provider Name (Legal Business Name): JOSE LUIS PAREDES AMADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DODGE ST
BEVERLY MA
01915-1705
US

IV. Provider business mailing address

7 COUNTRY DR
BEVERLY MA
01915-2627
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-0060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH232883
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: