Healthcare Provider Details

I. General information

NPI: 1639775653
Provider Name (Legal Business Name): MRS. SHANNON GUZZINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WASHINGTON ST
CANTON MA
02021-4006
US

IV. Provider business mailing address

95 WASHINGTON ST
CANTON MA
02021-4006
US

V. Phone/Fax

Practice location:
  • Phone: 781-828-5125
  • Fax:
Mailing address:
  • Phone: 781-828-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH238976
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: