Healthcare Provider Details

I. General information

NPI: 1417646159
Provider Name (Legal Business Name): MEGAN PHU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 BOSTON RD
SPRINGFIELD MA
01129
US

IV. Provider business mailing address

45 RISING ST
FEEDING HILLS MA
01030
US

V. Phone/Fax

Practice location:
  • Phone: 413-543-0638
  • Fax:
Mailing address:
  • Phone: 781-970-2597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH241384
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: