Healthcare Provider Details

I. General information

NPI: 1154926467
Provider Name (Legal Business Name): JAMES MELVIN PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CABOT RD
MEDFORD MA
02155-5117
US

IV. Provider business mailing address

1 CABOT RD
MEDFORD MA
02155-5117
US

V. Phone/Fax

Practice location:
  • Phone: 617-591-6820
  • Fax: 617-591-6821
Mailing address:
  • Phone: 617-591-6820
  • Fax: 617-591-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH23018
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: