Healthcare Provider Details

I. General information

NPI: 1649795238
Provider Name (Legal Business Name): OLIVIA NUTTALL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CANAL ST
MALDEN MA
02148-6701
US

IV. Provider business mailing address

46 WARREN ST
TAUNTON MA
02780-1655
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-8990
  • Fax:
Mailing address:
  • Phone: 774-226-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH237510
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: