=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023618402
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARREN MICHAEL LEBEAU RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2020
-----------------------------------------------------
Last Update Date | 10/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1105 BOSTON RD
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01119-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-782-6897
-----------------------------------------------------
Fax | 413-783-5838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 PAIGE HILL RD
-----------------------------------------------------
City | BRIMFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01010-9777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-531-4740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH26854
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------