Healthcare Provider Details

I. General information

NPI: 1316070840
Provider Name (Legal Business Name): DEBORAH J GUERTIN BS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WESTFIELD ST
W SPRINGFIELD MA
01089-2550
US

IV. Provider business mailing address

99 WESTFIELD ST
W SPRINGFIELD MA
01089-2550
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-6523
  • Fax: 413-788-4965
Mailing address:
  • Phone: 413-737-6523
  • Fax: 413-788-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19121
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: