Healthcare Provider Details

I. General information

NPI: 1093114258
Provider Name (Legal Business Name): JAY MICHAEL O'DWYER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HUTTLESTON AVE
FAIRHAVEN MA
02719-1958
US

IV. Provider business mailing address

476 MOUNT HOPE AVE APT 2
FALL RIVER MA
02724-1724
US

V. Phone/Fax

Practice location:
  • Phone: 508-993-7498
  • Fax: 508-993-8248
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH235425
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: