Healthcare Provider Details

I. General information

NPI: 1639272917
Provider Name (Legal Business Name): ASHBURNHAM FAMILY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAIN ST
ASHBURNHAM MA
01430-1247
US

IV. Provider business mailing address

100 GROVE ST SUITE 201
WORCESTER MA
01605-2627
US

V. Phone/Fax

Practice location:
  • Phone: 978-827-6766
  • Fax: 978-827-6665
Mailing address:
  • Phone: 508-755-4173
  • Fax: 508-755-4524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3314
License Number StateMA

VIII. Authorized Official

Name: MR. HAMID MOHAGHEGH
Title or Position: OWNER/PRESIDENT
Credential: RPH, MS, MHA
Phone: 508-755-4173