Healthcare Provider Details

I. General information

NPI: 1891390407
Provider Name (Legal Business Name): MICHAEL WHALLEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W BOYLSTON ST
WORCESTER MA
01605-1261
US

IV. Provider business mailing address

44 W BOYLSTON ST
WORCESTER MA
01605-1261
US

V. Phone/Fax

Practice location:
  • Phone: 508-852-0238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-01084
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number237476
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: