Healthcare Provider Details

I. General information

NPI: 1487122719
Provider Name (Legal Business Name): BRIDGET C SCULLION PHARMD, BCOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE DEPT OF
BOSTON MA
02215-5450
US

IV. Provider business mailing address

450 BROOKLINE AVE DEPT OF
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-4261
  • Fax:
Mailing address:
  • Phone: 617-632-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPH25263
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH25263
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: