Healthcare Provider Details

I. General information

NPI: 1013608454
Provider Name (Legal Business Name): THOMAS MICHAEL ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE # BN06
BOSTON MA
02118-4001
US

IV. Provider business mailing address

154 GRANT AVE
MEDFORD MA
02155-2765
US

V. Phone/Fax

Practice location:
  • Phone: 781-475-9466
  • Fax:
Mailing address:
  • Phone: 781-475-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT18426
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: