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General NPI Number Information
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NPI Number | 1740615251
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Entity Type | Organization
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Legal Business Name | NKANYIMUO REAL ESTATE LLC
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 320 BLUE HILL AVE STORE
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City | DORCHESTER
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State | MA
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Zip | 02121-1951
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Country | US
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Telephone | 617-652-7546
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Fax | 617-652-7561
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Provider Business Mailing Address
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Address Line | BLUE HILL PHARMACY 320 BLUE HILL AVE.
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City | DORCHESTER
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State | MA
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Zip | 02121-1951
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Country | US
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Telephone | 617-652-7546
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Fax | 617-652-7561
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Authorized Official
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Title or Position | OWNER/ PHARMACIST-IN-CHARGE
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Name | MS. VICTORIA N OKEKE
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Credential | RPH
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Telephone | 617-652-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | DS89942
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License Number State | MA
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