Basic Information
| Provider Information | |||||||||
| NPI: | 1568941441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHFOUZ | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | COPELAND | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARMD, RPH | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | COPELAND | ||||||||
| OtherFirstName: | DEBRA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | PHARMD, RPH | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1135 MORTON ST | ||||||||
| Address2: | |||||||||
| City: | MATTAPAN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021262834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175332300 | ||||||||
| FaxNumber: | 6172821582 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 ATTUCKS LN | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026011867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087780300 | ||||||||
| FaxNumber: | 5087785478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2018 | ||||||||
| LastUpdateDate: | 08/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 21098 | MA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.