MEDICARE: MICHAEL LACAVA

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	20440	MA

General Provider Information

NPI Number	:	1538743240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LACAVA

Provider Business Mailing Address
First Line	:	197 W MOUNTAIN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-2900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 CEDAR HILL ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-3057
Country	:	US
Telephone Number	:	508-624-8880
Fax Number	:

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

Provider Enumeration Date	:	05/09/2021
Last Update Date	:	05/09/2021

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Directions to “ MICHAEL LACAVA ” Practice Location

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