Healthcare Provider Details

I. General information

NPI: 1073930541
Provider Name (Legal Business Name): WILLIAM NOLAN JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2014
Last Update Date: 03/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 BLOSSOM ST
BOSTON MA
02114-2601
US

IV. Provider business mailing address

12 GIRDLESTONE RD APT 1
WINTHROP MA
02152-2730
US

V. Phone/Fax

Practice location:
  • Phone: 617-722-3000
  • Fax: 617-371-4810
Mailing address:
  • Phone: 617-207-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25075
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: