Healthcare Provider Details

I. General information

NPI: 1013037712
Provider Name (Legal Business Name): BRENDA L DODSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

52 CEDAR ST
WALTHAM MA
02453-5926
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-2218
  • Fax: 617-730-0601
Mailing address:
  • Phone: 781-209-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24195
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: