Individual
MATTHEW PETER ILSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD RPH
Contact information
Practice address
21 STANHOPE ST, BOSTON, MA 02116-5111
(617) 375-7969
Mailing address
21 STANHOPE ST, BOSTON, MA 02116-5111
(617) 375-7969
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
27573
MA
Other
Enumeration date
11/25/2008
Last updated
11/25/2008
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