Healthcare Provider Details

I. General information

NPI: 1184227464
Provider Name (Legal Business Name): ALYSSA Y HSU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N PEARL ST
BROCKTON MA
02301-1101
US

IV. Provider business mailing address

475 MASSAPOAG AVE
SHARON MA
02067-3133
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-0605
  • Fax:
Mailing address:
  • Phone: 617-281-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23855
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: