MEDICARE: MR. EDWARD J BISAGA RPH

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	1835X0200X	Oncology Pharmacist	17877	MA

General Provider Information

NPI Number	:	1568681591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD J BISAGA RPH

Provider Business Mailing Address
First Line	:	68 LANDSEER ST
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-3437
Country	:	US
Telephone Number	:	617-638-6775
Fax Number	:	617-638-5756

Provider Business Practice Location Address
First Line	:	68 LANDSEER ST
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-3437
Country	:	US
Telephone Number	:	617-638-6775
Fax Number	:	617-638-5756

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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