Provider Demographics
NPI:1205473162
Name:BOSTON MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:BOSTON MEDICAL CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BHAVESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-638-6789
Mailing Address - Street 1:850 HARRISON AVE BSMT BCN7
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4001
Mailing Address - Country:US
Mailing Address - Phone:617-414-5377
Mailing Address - Fax:
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3510
Practice Address - Country:US
Practice Address - Phone:617-638-8150
Practice Address - Fax:617-638-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy