Healthcare Provider Details

I. General information

NPI: 1508722380
Provider Name (Legal Business Name): THOMAS RAGHEB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 DEDHAM ST STE 300
CANTON MA
02021-1420
US

IV. Provider business mailing address

31 HAMLIN LN APT B24
NEEDHAM MA
02492-4635
US

V. Phone/Fax

Practice location:
  • Phone: 833-277-6352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License NumberPH1002779
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: