Healthcare Provider Details

I. General information

NPI: 1194328047
Provider Name (Legal Business Name): DEBBIE SOUSA PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GILBERT ST
NORTH BROOKFIELD MA
01535-1409
US

IV. Provider business mailing address

5 GILBERT ST
NORTH BROOKFIELD MA
01535-1409
US

V. Phone/Fax

Practice location:
  • Phone: 508-867-4891
  • Fax: 508-867-4896
Mailing address:
  • Phone: 508-867-4891
  • Fax: 508-867-4896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-00844
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH06040
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0014737
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH238254
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: