Provider Demographics
NPI:1164010765
Name:SELFRX LLC
Entity Type:Organization
Organization Name:SELFRX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-600-6500
Mailing Address - Street 1:8 WHITTIER PL APT 19H
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1410
Mailing Address - Country:US
Mailing Address - Phone:508-654-8520
Mailing Address - Fax:
Practice Address - Street 1:8 WHITTIER PL APT 19H
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1410
Practice Address - Country:US
Practice Address - Phone:508-654-8520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty