Healthcare Provider Details

I. General information

NPI: 1669393682
Provider Name (Legal Business Name): BOSTON MEDICAL CENTER - SOUTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 N PEARL ST
BROCKTON MA
02301-1708
US

IV. Provider business mailing address

34 N PEARL ST
BROCKTON MA
02301-1708
US

V. Phone/Fax

Practice location:
  • Phone: 508-408-9320
  • Fax: 857-241-5492
Mailing address:
  • Phone: 508-408-9320
  • Fax: 857-241-5492

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: MARK JAY HEICHMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 857-310-3991