=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467420398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALPI SIMA STEPANIAN PHARM.D., CDM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2006
-----------------------------------------------------
Last Update Date | 07/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 93 WORCESTER ST
-----------------------------------------------------
City | WELLESLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02481-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-509-5769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 WHITE ST
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02478-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-750-2498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 25708
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------