Provider Demographics
NPI:1164878013
Name:CAMBRIDGE PUBLIC HEALTH COMMISSION
Entity Type:Organization
Organization Name:CAMBRIDGE PUBLIC HEALTH COMMISSION
Other - Org Name:CAMBRIDGE HLTH ALLIANCE OUTPATIENT PHCY EAST CAMBRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE CHIEF PHARMACY OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSSILOS
Authorized Official - Suffix:
Authorized Official - Credentials:MARIA KOSSILOS BS IN
Authorized Official - Phone:617-806-8505
Mailing Address - Street 1:163 GORE ST
Mailing Address - Street 2:
Mailing Address - City:EAST CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1119
Mailing Address - Country:US
Mailing Address - Phone:617-499-6690
Mailing Address - Fax:617-499-6691
Practice Address - Street 1:163 GORE ST
Practice Address - Street 2:
Practice Address - City:EAST CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1119
Practice Address - Country:US
Practice Address - Phone:617-499-6690
Practice Address - Fax:617-499-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS900393336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy