=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518747310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENE SKRYPNYCHENKO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2023
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 413 WASHINGTON ST
-----------------------------------------------------
City | STOUGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02072-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-344-5600
-----------------------------------------------------
Fax | 781-344-0892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 294 HOWARD ST
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02370-1816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-650-7652
-----------------------------------------------------
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 | 033.0135017
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH996978
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------