Healthcare Provider Details

I. General information

NPI: 1902991573
Provider Name (Legal Business Name): MGH OUTPATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT STREET GRB 005-ATTENTION KAREN RYLE
BOSTON MA
02114
US

IV. Provider business mailing address

55 FRUIT STREET GRB 005-ATTENTION KAREN RYLE
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-3100
  • Fax: 617-726-3789
Mailing address:
  • Phone: 617-724-3100
  • Fax: 617-726-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN MARIE RYLE
Title or Position: ASSOCIATE CHIEF OF PHARMACY
Credential: MS RPH
Phone: 617-724-9154