1871874404 NPI number — DR. JUSTIN STEIN PHARM.D

Table of content: DR. JUSTIN STEIN PHARM.D (NPI 1871874404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871874404 NPI number — DR. JUSTIN STEIN PHARM.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIN
Provider First Name:
JUSTIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D
Provider Gender Code:
M

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:
1871874404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1890 COLUMBUS AVE
Provider Second Line Business Mailing Address:
ATTN: PHARMACY
Provider Business Mailing Address City Name:
ROXBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02119-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-445-4545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
ATTN: PHARMACY
Provider Business Practice Location Address City Name:
ROXBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02119-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-445-4545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH26240 , 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)

  • Identifier: PH26240 . This is a "MASS PHARMACY LISCENSE NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".