Provider Demographics
NPI:1194328997
Name:SOUZA, SETH MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:MICHAEL
Last Name:SOUZA
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 1:495 GRAND UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1446
Mailing Address - Country:US
Mailing Address - Phone:617-616-1065
Mailing Address - Fax:857-504-6241
Practice Address - Street 1:495 GRAND UNION BLVD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1446
Practice Address - Country:US
Practice Address - Phone:617-616-1065
Practice Address - Fax:857-504-6241
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist