Healthcare Provider Details

I. General information

NPI: 1215864897
Provider Name (Legal Business Name): EMILY GAUKHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 HIGH LEDGE AVE
WELLESLEY MA
02482-1042
US

IV. Provider business mailing address

59 HIGH LEDGE AVE
WELLESLEY MA
02482-1042
US

V. Phone/Fax

Practice location:
  • Phone: 904-614-0448
  • Fax:
Mailing address:
  • Phone: 904-614-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH27607
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: