Provider Demographics
NPI:1689992877
Name:D'AGOSTINO, EDWARD ANTHONY (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ANTHONY
Last Name:D'AGOSTINO
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 MASSACHUSETTS AVE
Mailing Address - Street 2:18E
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-876-7662
Mailing Address - Fax:
Practice Address - Street 1:1740 MASSACHUSETTS AVE
Practice Address - Street 2:18E
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-876-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist