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General NPI Number Information
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NPI Number | 1720828189
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Entity Type | Individual
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Provider Name | GRACE MOSALLAM RPH
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Gender | Female
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 264 W BOYLSTON ST
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City | WEST BOYLSTON
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State | MA
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Zip | 01583-1729
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Country | US
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Telephone | 781-492-4895
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Fax |
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Provider Business Mailing Address
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Address Line | 20 HILLTOP ST
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City | NORTH GRAFTON
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State | MA
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Zip | 01536-1271
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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 |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH997315
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License Number State | MA
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