Provider Demographics
NPI:1114522687
Name:DWYER, JAMES CHARLES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CHARLES
Last Name:DWYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-2911
Mailing Address - Country:US
Mailing Address - Phone:781-335-0404
Mailing Address - Fax:781-682-1025
Practice Address - Street 1:474 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2911
Practice Address - Country:US
Practice Address - Phone:781-335-0404
Practice Address - Fax:781-682-1025
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH19444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist