Individual provider Active NPI

John D Leary Jr., PHARMACIST

  • Pharmacist
  • Brighton, MA
National Provider Identifier
1417983313
Registry record updated Jun 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
18373 Issued in MA
Practice address
1690 Commonwealth Ave
Brighton, MA 02135-5602
Phone
(617) 232-3513
Fax
(617) 232-1569
NPI assigned
Jun 23, 2006
Last updated
Jun 22, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 18373 MA Primary

Addresses

Primary practice location

1690 Commonwealth Ave
Brighton, MA 02135-5602

Mailing address

1690 Commonwealth Ave
Brighton, MA 02135-5602
Phone (617) 232-3513

Other identifiers 2

IdentifierTypeStateIssuer
0400076MedicaidMA
2204662OtherNABP NUMBER

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

LicenseStateTypeSpecialty
18373MAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Sutherland Pharmacy LLC Pharmacist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308700800000",
    "number": "1417983313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1690 COMMONWEALTH AVE",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021355602",
            "telephone_number": "617-232-3513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 COMMONWEALTH AVE",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021355602",
            "telephone_number": "617-232-3513",
            "fax_number": "617-232-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEARY",
        "first_name": "JOHN",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PHARMACIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2011-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "18373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0400076",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "2204662",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.