Healthcare Provider Details

I. General information

NPI: 1659360535
Provider Name (Legal Business Name): DAVID O SMALL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PLEASANT ST
NANTUCKET MA
02554-4003
US

IV. Provider business mailing address

23 DAFFODIL LN
NANTUCKET MA
02554-6014
US

V. Phone/Fax

Practice location:
  • Phone: 508-228-6400
  • Fax: 508-228-1375
Mailing address:
  • Phone: 508-221-1733
  • Fax: 508-228-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20099
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: