Healthcare Provider Details

I. General information

NPI: 1740615251
Provider Name (Legal Business Name): NKANYIMUO REAL ESTATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 06/29/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BLUE HILL AVE STORE
DORCHESTER MA
02121-1951
US

IV. Provider business mailing address

BLUE HILL PHARMACY 320 BLUE HILL AVE.
DORCHESTER MA
02121-1951
US

V. Phone/Fax

Practice location:
  • Phone: 617-652-7546
  • Fax: 617-652-7561
Mailing address:
  • Phone: 617-652-7546
  • Fax: 617-652-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS89942
License Number StateMA

VIII. Authorized Official

Name: MS. VICTORIA N OKEKE
Title or Position: OWNER/ PHARMACIST-IN-CHARGE
Credential: RPH
Phone: 617-652-7546