MEDICARE: DR. BRYAN RICHARD WOOD PHARMD

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
1	1835P1200X	Pharmacotherapy Pharmacist	25883	MA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	25883	MA
3	1835P2201X	Ambulatory Care Pharmacist	25883	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25883	OTHER		DPH

General Provider Information

NPI Number	:	1306890686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN RICHARD WOOD PHARMD

Provider Business Mailing Address
First Line	:	150 S HUNTINGTON AVE
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4817
Country	:	US
Telephone Number	:	857-203-5213
Fax Number	:	857-203-5780

Provider Business Practice Location Address
First Line	:	150 S HUNTINGTON AVE
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4817
Country	:	US
Telephone Number	:	857-203-5213
Fax Number	:	857-203-5780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/18/2016

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