Healthcare Provider Details

I. General information

NPI: 1255936936
Provider Name (Legal Business Name): KYLE WOJCIECHOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE # CVS
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE # CVS
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-975-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number237292
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: