Provider Demographics
NPI:1275424590
Name:SHANG, JACQUELINE (PHARMD, MPH)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SHANG
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MISSION ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6308
Mailing Address - Country:US
Mailing Address - Phone:626-371-6627
Mailing Address - Fax:
Practice Address - Street 1:1070 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-7206
Practice Address - Country:US
Practice Address - Phone:781-891-0615
Practice Address - Fax:781-891-0615
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1000942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist