Healthcare Provider Details

I. General information

NPI: 1548543689
Provider Name (Legal Business Name): TASLEEM SPRACKLIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 11/21/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST # 5N
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-1940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH235242
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03451800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: