Healthcare Provider Details

I. General information

NPI: 1023157351
Provider Name (Legal Business Name): PRESIDENT & FELLOWS OF HARVARD COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MOUNT AUBURN ST
CAMBRIDGE MA
02138-4960
US

IV. Provider business mailing address

75 MOUNT AUBURN ST
CAMBRIDGE MA
02138-4960
US

V. Phone/Fax

Practice location:
  • Phone: 617-496-6661
  • Fax: 617-495-0595
Mailing address:
  • Phone: 617-496-6664
  • Fax: 617-495-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberMA0056172
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BENEDICT DIRUSSO
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 617-496-6661