1356841662 NPI number — PHARMACEUTICALLY ELEGANT INC

Table of content: (NPI 1356841662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356841662 NPI number — PHARMACEUTICALLY ELEGANT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACEUTICALLY ELEGANT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356841662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01940-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-334-3133
Provider Business Mailing Address Fax Number:
781-334-3838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01940-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-334-3133
Provider Business Practice Location Address Fax Number:
781-334-3838
Provider Enumeration Date:
02/14/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMBREFE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
781-334-3133

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  DS2940 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)