=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689144982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHAM & WOMENS HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2018
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 FRANCIS ST
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02115-6105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-732-6233
-----------------------------------------------------
Fax | 617-732-4205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 FRANCIS ST
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02115-6105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-732-6233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | GREGORY DIERKS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 617-732-6225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------