Provider Demographics
NPI:1568681591
Name:BISAGA, EDWARD J (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:BISAGA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:68 LANDSEER ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3437
Mailing Address - Country:US
Mailing Address - Phone:617-638-6775
Mailing Address - Fax:617-638-5756
Practice Address - Street 1:68 LANDSEER ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-3437
Practice Address - Country:US
Practice Address - Phone:617-638-6775
Practice Address - Fax:617-638-5756
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA178771835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology