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NPI Code Detail

MEDICARE: MARY LO

MEDICARE: MARY LO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPH22340MA

General Provider Information

NPI Number : 1104542687
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LO
Provider Business Mailing Address
First Line : 655 MOUNT AUBURN ST
Second Line :
City : WATERTOWN
State : MA
Zip : 02472-2017
Country : US
Telephone Number : 617-744-0842
Fax Number :
Provider Business Practice Location Address
First Line : 655 MOUNT AUBURN ST
Second Line :
City : WATERTOWN
State : MA
Zip : 02472-2017
Country : US
Telephone Number : 617-744-0842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2022
Last Update Date : 10/17/2022

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Directions to “ MARY LO ” Practice Location

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