Healthcare Provider Details

I. General information

NPI: 1467389924
Provider Name (Legal Business Name): TIEN-SHU MIAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 REVOLUTION DR STE 950
SOMERVILLE MA
02145-1579
US

IV. Provider business mailing address

68 HARRISON AVE STE 605 PMB 192352
BOSTON MA
02111-1929
US

V. Phone/Fax

Practice location:
  • Phone: 857-304-5930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH240994
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: