Provider Demographics
NPI:1366442493
Name:DOHERTY, LEO FRANCIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:FRANCIS
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GAY ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-1430
Mailing Address - Country:US
Mailing Address - Phone:781-646-3827
Mailing Address - Fax:
Practice Address - Street 1:8 GAY ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-1430
Practice Address - Country:US
Practice Address - Phone:781-646-3827
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist