=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699537175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH JOAN MAGIERA RPH PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2024
-----------------------------------------------------
Last Update Date | 01/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 VINEYARD HAVEN ROAD
-----------------------------------------------------
City | EDGARTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-627-5107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3247
-----------------------------------------------------
City | OAK BLUFFS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02557-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-569-7754
-----------------------------------------------------
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 | 21252
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------