Healthcare Provider Details

I. General information

NPI: 1669754032
Provider Name (Legal Business Name): MARY THERESA DURANTE PHARMD, R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 FRIEND ST
LYNN MA
01902-3068
US

IV. Provider business mailing address

37 FRIEND ST
LYNN MA
01902-3068
US

V. Phone/Fax

Practice location:
  • Phone: 781-715-6696
  • Fax: 781-268-5070
Mailing address:
  • Phone: 781-715-6696
  • Fax: 781-268-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number026102
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: