Provider Demographics
NPI:1194711705
Name:MACK, DALIA RASHAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DALIA
Middle Name:RASHAN
Last Name:MACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:75 SAINT ALPHONSUS ST
Mailing Address - Street 2:APT. 803
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1676
Mailing Address - Country:US
Mailing Address - Phone:617-740-2526
Mailing Address - Fax:
Practice Address - Street 1:75 SAINT ALPHONSUS ST
Practice Address - Street 2:APT. 803
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-1676
Practice Address - Country:US
Practice Address - Phone:617-740-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262941835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy