Healthcare Provider Details

I. General information

NPI: 1568941441
Provider Name (Legal Business Name): DEBRA COPELAND MAHFOUZ PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA COPELAND PHARMD, RPH

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 ATTUCKS LN
HYANNIS MA
02601-1867
US

IV. Provider business mailing address

1135 MORTON ST
MATTAPAN MA
02126-2834
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-0300
  • Fax: 508-778-5478
Mailing address:
  • Phone: 617-533-2300
  • Fax: 617-282-1582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21098
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: