Healthcare Provider Details

I. General information

NPI: 1104759075
Provider Name (Legal Business Name): NICOLE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

106 BOSTON RD
GROTON MA
01450-1860
US

IV. Provider business mailing address

267 ARLINGTON ST
ACTON MA
01720-2246
US

V. Phone/Fax

Practice location:
  • Phone: 978-448-5249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH240391
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: