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NPI Code Detail

MEDICARE: MR. ROBERT O'DONOGHUE JR.

MEDICARE: MR. ROBERT O'DONOGHUE JR.
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
1183500000XPharmacist23691MA

General Provider Information

NPI Number : 1205118726
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT O'DONOGHUE JR.
Provider Business Mailing Address
First Line : 99 HARVARD ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-6403
Country : US
Telephone Number : 617-731-4536
Fax Number : 617-731-9140
Provider Business Practice Location Address
First Line : 99 HARVARD ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-6403
Country : US
Telephone Number : 617-731-4536
Fax Number : 617-731-9140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2011
Last Update Date : 09/10/2011

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