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General NPI Number Information
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NPI Number | 1366920381
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Entity Type | Individual
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Provider Name | ENIOLA BISOLA TUBY-LUKAN
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Gender | Female
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 270 UNION ST
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City | LYNN
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State | MA
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Zip | 01901-1348
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Country | US
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Telephone | 781-593-4805
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Fax | 781-593-5275
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Provider Business Mailing Address
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Address Line | 130 HARVARD ST
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City | MALDEN
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State | MA
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Zip | 02148-7903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHCY-04475
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH238651
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License Number State | MA
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