Provider Demographics
NPI:1134434376
Name:FEDERICO, MARY REBECCA (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:REBECCA
Last Name:FEDERICO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7151
Mailing Address - Country:US
Mailing Address - Phone:978-683-4980
Mailing Address - Fax:978-683-3294
Practice Address - Street 1:256 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7151
Practice Address - Country:US
Practice Address - Phone:978-683-4980
Practice Address - Fax:978-683-3294
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist