| NPI | 1780619726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD DAYTO Director 617-770-8782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: VA 0201003271) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: VA 0201003271) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: VA 0201003271) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-09-23 |