Healthcare Provider Details

I. General information

NPI: 1801385380
Provider Name (Legal Business Name): ENDEAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MOUNT AUBURN ST STE 102
CAMBRIDGE MA
02138-4555
US

IV. Provider business mailing address

625 MOUNT AUBURN ST STE 102
CAMBRIDGE MA
02138-4555
US

V. Phone/Fax

Practice location:
  • Phone: 781-698-5491
  • Fax: 855-829-6228
Mailing address:
  • Phone: 781-608-8128
  • Fax: 855-829-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUFANG SHI
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 781-608-8128