Healthcare Provider Details

I. General information

NPI: 1992620710
Provider Name (Legal Business Name): CARLY SANDERSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
JAMAICA PLAIN MA
02130-4817
US

IV. Provider business mailing address

6 WHIRTY CIR
HOPKINTON MA
01748-2350
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax:
Mailing address:
  • Phone: 508-902-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1003834
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: