Healthcare Provider Details

I. General information

NPI: 1588864409
Provider Name (Legal Business Name): ANNA LOUISE HEGARTY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HIGHLAND AVE
SOMERVILLE MA
02143-1408
US

IV. Provider business mailing address

230 HIGHLAND AVE
SOMERVILLE MA
02143-1408
US

V. Phone/Fax

Practice location:
  • Phone: 617-591-4200
  • Fax: 617-591-4202
Mailing address:
  • Phone: 617-591-4200
  • Fax: 617-591-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: