MEDICARE: NANTASKET PHARMACY 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	DS2038	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2035633	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629122072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANTASKET PHARMACY INC

Provider Business Mailing Address
First Line	:	480 NANTASKET AVE
Second Line	:
City	:	HULL
State	:	MA
Zip	:	02045-2521
Country	:	US
Telephone Number	:	781-925-1270
Fax Number	:	781-925-0551

Provider Business Practice Location Address
First Line	:	480 NANTASKET AVE
Second Line	:
City	:	HULL
State	:	MA
Zip	:	02045-2521
Country	:	US
Telephone Number	:	781-925-1270
Fax Number	:	781-925-0551

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROCKY TENUGLIA
Credential	:	RPH
Telephone Number	:	781-925-2378

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	11/23/2016

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Directions to “NANTASKET PHARMACY INC ” Practice Location

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