Provider Demographics
NPI:1538845987
Name:XAVIER, TIAGO COSTA (PHARMACY INTERN)
Entity type:Individual
Prefix:
First Name:TIAGO
Middle Name:COSTA
Last Name:XAVIER
Suffix:
Gender:M
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CLARENDON ST # 1
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7614
Mailing Address - Country:US
Mailing Address - Phone:178-166-6035
Mailing Address - Fax:
Practice Address - Street 1:625 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3357
Practice Address - Country:US
Practice Address - Phone:617-491-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician