Provider Demographics
NPI:1619385267
Name:CALIXTE, DAVID J (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CALIXTE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 WEST ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4020
Mailing Address - Country:US
Mailing Address - Phone:617-201-2289
Mailing Address - Fax:
Practice Address - Street 1:25 TOBIAS BOLAND WAY
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-2103
Practice Address - Country:US
Practice Address - Phone:774-314-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist