Healthcare Provider Details

I. General information

NPI: 1558427823
Provider Name (Legal Business Name): CAMBRIDGE PUBLIC HEALTH COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1438
  • Fax: 617-665-1148
Mailing address:
  • Phone: 617-665-1438
  • Fax: 617-665-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3051
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARIA KOSSILOS
Title or Position: PHARMACY DIRECTOR
Credential: BS IN PHARMACY
Phone: 617-806-8505