Provider Demographics
NPI:1477130987
Name:DEOCAMPO, NIMIT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NIMIT
Middle Name:
Last Name:DEOCAMPO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SALEM ST APT 90
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1584
Mailing Address - Country:US
Mailing Address - Phone:781-632-1920
Mailing Address - Fax:
Practice Address - Street 1:600 CUMMINGS CTR STE 165Z
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:781-632-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist