Active NPI
Elizabeth Gultom
- Pharmacist
- Arlington, MA
National Provider Identifier
1043953664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH240591
- Practice address
- 324 Massachusetts Ave
Arlington, MA 02474-8392 - Phone
- (781) 643-4112
- NPI assigned
- Apr 20, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH240591 | MA | Primary |
Addresses
Primary practice location
324 Massachusetts Ave
Arlington, MA 02474-8392
Mailing address
15 Saint Mary St
Medford, MA 02155-2827
Phone (617) 676-8930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH240591 | MA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Eastern Co Inc | Current | Accepting new patients | |
| Walgreen Eastern Co Inc | Past | Accepting new patients |
Locations
324 Massachusetts Ave
Arlington, MA 02474
Phone (781) 643-4110
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650499200000",
"number": "1043953664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 SAINT MARY ST",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021552827",
"telephone_number": "617-676-8930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 MASSACHUSETTS AVE",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "024748392",
"telephone_number": "781-643-4112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GULTOM",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-20",
"last_updated": "2022-04-21",
"certification_date": "2022-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH240591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.