Healthcare Provider Details

I. General information

NPI: 1932879095
Provider Name (Legal Business Name): DYLAN MORIARTY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIGHAM AND WOMEN'S HOSPITAL 1249 BOYLSTON STREET
BOSTON MA
02215
US

IV. Provider business mailing address

27 WABON ST # 2
BOSTON MA
02121-1201
US

V. Phone/Fax

Practice location:
  • Phone: 617-264-3000
  • Fax:
Mailing address:
  • Phone: 207-798-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH82592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number99108572
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH238485
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: