Healthcare Provider Details

I. General information

NPI: 1669592762
Provider Name (Legal Business Name): JACOB SHER CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

21 HEWS ST UNIT 3
CAMBRIDGE MA
02139-2907
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7395
  • Fax: 617-730-0601
Mailing address:
  • Phone: 412-719-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number7095
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: