Healthcare Provider Details

I. General information

NPI: 1487922985
Provider Name (Legal Business Name): CASSANDRA RENEE CLARK GEDRAITIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 MAIN ST
ATHOL MA
01331-2640
US

IV. Provider business mailing address

11 INDIAN HILL RD
PAXTON MA
01612-1419
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-6715
  • Fax: 978-249-9965
Mailing address:
  • Phone: 978-249-6715
  • Fax: 978-249-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007760
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH239886
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: