Provider Demographics
NPI:1801385380
Name:ENDEAR INC
Entity type:Organization
Organization Name:ENDEAR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JUFANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:781-608-8128
Mailing Address - Street 1:625 MOUNT AUBURN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4555
Mailing Address - Country:US
Mailing Address - Phone:781-608-8128
Mailing Address - Fax:855-829-6228
Practice Address - Street 1:625 MOUNT AUBURN ST STE 102
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4555
Practice Address - Country:US
Practice Address - Phone:781-698-5491
Practice Address - Fax:855-829-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty PharmacyGroup - Multi-Specialty
Yes333600000XSuppliersPharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000041HUMedicaid