Healthcare Provider Details

I. General information

NPI: 1427680743
Provider Name (Legal Business Name): CAMBRIDGE PUBLIC HEALTH COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN STREET SUITE 640
MALDEN MA
02148
US

IV. Provider business mailing address

350 MAIN STREET SUITE 640
MALDEN MA
02148
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-0670
  • Fax: 781-338-0690
Mailing address:
  • Phone: 781-338-0670
  • Fax: 781-338-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARIA KOSSILOS
Title or Position: ASSOCIATE CHIEF PHARMACY OFFICER
Credential:
Phone: 617-806-8505