Provider Demographics
NPI:1558180513
Name:NOME, MICHAEL NNAMDI (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NNAMDI
Last Name:NOME
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 1:6 JFK ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4909
Mailing Address - Country:US
Mailing Address - Phone:617-354-4420
Mailing Address - Fax:617-491-7807
Practice Address - Street 1:6 JFK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4909
Practice Address - Country:US
Practice Address - Phone:617-354-4420
Practice Address - Fax:617-491-7807
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1001101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist