MEDICARE: NORTHEAST RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336H0001X	Home Infusion Therapy Pharmacy
5	3336M0002X	Mail Order Pharmacy
6	3336S0011X	Specialty Pharmacy
7	333600000X	Pharmacy	DS89832	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2039805	OTHER		PK

General Provider Information

NPI Number	:	1225291875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST RX INC

Provider Business Mailing Address
First Line	:	PO BOX 446
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-0446
Country	:	US
Telephone Number	:	508-564-6288
Fax Number	:	508-563-2571

Provider Business Practice Location Address
First Line	:	111B COUNTY RD
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-2019
Country	:	US
Telephone Number	:	800-457-0096
Fax Number	:	508-563-2571

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH FERRARO
Credential	:
Telephone Number	:	800-457-0096

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	11/08/2013

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Directions to “NORTHEAST RX INC ” Practice Location

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