Healthcare Provider Details

I. General information

NPI: 1265486682
Provider Name (Legal Business Name): LETOURNEAU'S PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 N MAIN ST
ANDOVER MA
01810-2687
US

IV. Provider business mailing address

349 N MAIN ST
ANDOVER MA
01810-2687
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-7779
  • Fax: 978-475-1662
Mailing address:
  • Phone: 978-475-7779
  • Fax: 978-475-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2777
License Number StateMA

VIII. Authorized Official

Name: DANIEL MCKALLAGAT
Title or Position: OWNER/ DIRECTOR
Credential:
Phone: 978-475-7779