Healthcare Provider Details

I. General information

NPI: 1619676145
Provider Name (Legal Business Name): DREW GOODRICH PHARMD, BCPPS, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-2332
  • Fax:
Mailing address:
  • Phone: 617-636-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number8151440
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH238139
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: