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General NPI Number Information
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NPI Number | 1629925177
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Entity Type | Organization
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Legal Business Name | EMILY BUKOVICH, LLC DBA JANNABIS WELLNESS
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 6 CHAPMAN ST
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City | WATERTOWN
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State | MA
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Zip | 02472-1779
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Country | US
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Telephone | 781-640-6594
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Fax |
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Provider Business Mailing Address
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Address Line | 6 CHAPMAN ST
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City | WATERTOWN
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State | MA
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Zip | 02472-1779
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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 | CEO
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Name | EMILY BUKOVICH
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Credential | MS, RDN, IFNCP
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Telephone | 781-640-6594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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