Healthcare Provider Details

I. General information

NPI: 1164878013
Provider Name (Legal Business Name): CAMBRIDGE PUBLIC HEALTH COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 GORE ST
EAST CAMBRIDGE MA
02141-1119
US

IV. Provider business mailing address

163 GORE ST
EAST CAMBRIDGE MA
02141-1119
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-6690
  • Fax: 617-499-6691
Mailing address:
  • Phone: 617-499-6690
  • Fax: 617-499-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS90039
License Number StateMA

VIII. Authorized Official

Name: MRS. MARIA KOSSILOS
Title or Position: ASSOCIATE CHIEF PHARMACY OFFICER
Credential: MARIA KOSSILOS BS IN
Phone: 617-806-8505