MEDICARE: JORGE ALBERTO BERNOTI OBAYI

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	183500000X	Pharmacist	PH232437	MA

General Provider Information

NPI Number	:	1932826559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ALBERTO BERNOTI OBAYI

Provider Business Mailing Address
First Line	:	704 CENTRE ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2516
Country	:	US
Telephone Number	:	617-304-0650
Fax Number	:	617-522-8228

Provider Business Practice Location Address
First Line	:	704 CENTRE ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2516
Country	:	US
Telephone Number	:	617-304-0650
Fax Number	:	617-522-8228

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

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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Directions to “ JORGE ALBERTO BERNOTI OBAYI ” Practice Location

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