Healthcare Provider Details

I. General information

NPI: 1689537458
Provider Name (Legal Business Name): THERESA JEAN MICHELINI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WATER ST
CAMBRIDGE MA
02141-2288
US

IV. Provider business mailing address

197 8TH ST APT 232
CHARLESTOWN MA
02129-4245
US

V. Phone/Fax

Practice location:
  • Phone: 617-685-5225
  • Fax:
Mailing address:
  • Phone: 609-216-8332
  • Fax: 160-921-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026313
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: