Healthcare Provider Details

I. General information

NPI: 1891241816
Provider Name (Legal Business Name): CHARLES RIVER COMMUNITY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 WESTERN AVE
BRIGHTON MA
02135-1007
US

IV. Provider business mailing address

495 WESTERN AVE
BRIGHTON MA
02135-1007
US

V. Phone/Fax

Practice location:
  • Phone: 617-208-1656
  • Fax: 617-870-7459
Mailing address:
  • Phone: 617-208-1656
  • Fax: 617-870-7459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS90057
License Number StateMA

VIII. Authorized Official

Name: MATTHEW LOCKWOOD MULLANEY
Title or Position: CEO
Credential:
Phone: 617-783-0500