Healthcare Provider Details

I. General information

NPI: 1669473542
Provider Name (Legal Business Name): KAY-JAY PHARMACY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DEPOT ST
ADAMS MA
01220-1858
US

IV. Provider business mailing address

17 DEPOT ST
ADAMS MA
01220-1858
US

V. Phone/Fax

Practice location:
  • Phone: 413-743-5702
  • Fax: 413-743-0710
Mailing address:
  • Phone: 413-743-5702
  • Fax: 413-743-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number22759
License Number StateMA

VIII. Authorized Official

Name: MR. MICHAEL WILUSZ
Title or Position: PRES
Credential:
Phone: 413-743-5702