Provider Demographics
NPI:1558656454
Name:KAUFMAN, DOUGLAS
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:KAUFMAN
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 1:550 ARSENAL ST
Mailing Address - Street 2:T-1442
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2853
Mailing Address - Country:US
Mailing Address - Phone:617-924-5987
Mailing Address - Fax:
Practice Address - Street 1:550 ARSENAL ST
Practice Address - Street 2:T-1442
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2853
Practice Address - Country:US
Practice Address - Phone:617-924-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH22019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist