Healthcare Provider Details

I. General information

NPI: 1275468654
Provider Name (Legal Business Name): PRINTA JOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5928
US

IV. Provider business mailing address

200 MILL RD
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-9650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH233383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: