1023157351 NPI number — PRESIDENT & FELLOWS OF HARVARD COLLEGE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023157351 NPI number — PRESIDENT & FELLOWS OF HARVARD COLLEGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESIDENT & FELLOWS OF HARVARD COLLEGE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARVARD UNIVERSITY HEALTH SERVICES PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023157351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 MOUNT AUBURN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138-4960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-496-6664
Provider Business Mailing Address Fax Number:
617-495-0595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 MOUNT AUBURN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-4960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-496-6661
Provider Business Practice Location Address Fax Number:
617-495-0595
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIRUSSO
Authorized Official First Name:
BENEDICT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
617-496-6661

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: MA0056172 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2039939 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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