Provider Demographics
NPI:1780966150
Name:FERULLO, MARTINE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARTINE
Middle Name:
Last Name:FERULLO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:FERULLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:14 PLEASANT LN
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1547
Mailing Address - Country:US
Mailing Address - Phone:508-869-0462
Mailing Address - Fax:
Practice Address - Street 1:14 PLEASANT LN
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1547
Practice Address - Country:US
Practice Address - Phone:508-869-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24699183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric