Provider Demographics
NPI:1902991573
Name:MGH OUTPATIENT PHARMACY
Entity Type:Organization
Organization Name:MGH OUTPATIENT PHARMACY
Other - Org Name:MASSACHUSETTS GENERAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE CHIEF OF PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS RPH
Authorized Official - Phone:617-724-9154
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:GRB 005-ATTENTION KAREN RYLE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-3100
Mailing Address - Fax:617-726-3789
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:GRB 005-ATTENTION KAREN RYLE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-3100
Practice Address - Fax:617-726-3789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERAL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0446777Medicaid