Provider Demographics
NPI:1194042911
Name:PURTELL, EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:PURTELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1934
Mailing Address - Country:US
Mailing Address - Phone:508-478-3918
Mailing Address - Fax:
Practice Address - Street 1:237 BROADWAY
Practice Address - Street 2:RITAID PHARMACY
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1508
Practice Address - Country:US
Practice Address - Phone:508-880-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH18429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist