Healthcare Provider Details

I. General information

NPI: 1174510887
Provider Name (Legal Business Name): SOPHIE M MCINTYRE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOPE AVE EATON APOTHECARY
WALTHAM MA
02453-2741
US

IV. Provider business mailing address

30 CHARLOTTE RD
WALTHAM MA
02453-8220
US

V. Phone/Fax

Practice location:
  • Phone: 781-894-5400
  • Fax: 781-894-5421
Mailing address:
  • Phone: 508-429-8506
  • Fax: 781-894-5421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24160
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: