Healthcare Provider Details

I. General information

NPI: 1215380761
Provider Name (Legal Business Name): IMAN FATHY SULIMAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

450 BROOKLINE AVE # YC-537
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-6464
  • Fax:
Mailing address:
  • Phone: 617-632-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS55123
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH237497
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: