Healthcare Provider Details

I. General information

NPI: 1992372072
Provider Name (Legal Business Name): DRUG AND WELLNESS SCREENINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-11 DRYDOCK AVE STE 2020
BOSTON MA
02210-2520
US

IV. Provider business mailing address

5-11 DRYDOCK AVE STE 2020
BOSTON MA
02210-2520
US

V. Phone/Fax

Practice location:
  • Phone: 617-340-2500
  • Fax: 617-272-2240
Mailing address:
  • Phone: 617-340-2500
  • Fax: 617-272-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080I0007X
TaxonomyPediatric Clinical & Laboratory Immunology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. LANETTE MARIE DUGGAN
Title or Position: CEO
Credential:
Phone: 617-340-2500