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General NPI Number Information
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NPI Number | 1588506281
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Entity Type | Individual
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Provider Name | SHANNON GONIWIECHA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 450 BROOKLINE AVE
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City | BOSTON
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State | MA
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Zip | 02215-5418
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Country | US
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Telephone | 857-215-2038
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Fax | 586-419-7084
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Provider Business Mailing Address
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Address Line | 55 W 5TH ST PH 601
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City | SOUTH BOSTON
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State | MA
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Zip | 02127-5008
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Country | US
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Telephone | 586-419-7084
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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 | 1835X0200X
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Taxonomy Name | Oncology Pharmacist
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License Number | PH1001178
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License Number State | MA
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