Basic Information
| Provider Information | |||||||||
| NPI: | 1689109449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEMATICK | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 BROOKLINE AVE | ||||||||
| Address2: | Y5 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176326464 | ||||||||
| FaxNumber: | 6176326180 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 BROOKLINE AVE # Y5 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176326464 | ||||||||
| FaxNumber: | 6176326180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2017 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 061160 | NY | N | Pharmacy Service Providers | Pharmacist | 183500000X | 236942 | MA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.