Healthcare Provider Details

I. General information

NPI: 1972440337
Provider Name (Legal Business Name): LOTHIDA PHOTHISANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 DEPOT ST
NORTH EASTON MA
02356-2703
US

IV. Provider business mailing address

14 JAMES ST
HOLBROOK MA
02343-1808
US

V. Phone/Fax

Practice location:
  • Phone: 508-238-0604
  • Fax:
Mailing address:
  • Phone: 401-480-3462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH26866
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: