Provider Demographics
NPI:1073395836
Name:BOSTON MEDICAL CENTER CORPORATION
Entity Type:Organization
Organization Name:BOSTON MEDICAL CENTER CORPORATION
Other - Org Name:BMC PHARMACY AT CODMAN SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND CPO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TWITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-638-6799
Mailing Address - Street 1:637 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3510
Mailing Address - Country:US
Mailing Address - Phone:617-638-8150
Mailing Address - Fax:
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3510
Practice Address - Country:US
Practice Address - Phone:617-638-8150
Practice Address - Fax:617-638-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy