Healthcare Provider Details

I. General information

NPI: 1164029880
Provider Name (Legal Business Name): CARLOS ECHEVARRIA MALDONADO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAVERICK SQ
EAST BOSTON MA
02128-2335
US

IV. Provider business mailing address

10 GOVE ST
EAST BOSTON MA
02128-1920
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-5800
  • Fax:
Mailing address:
  • Phone: 617-569-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH239813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: