Healthcare Provider Details

I. General information

NPI: 1407398589
Provider Name (Legal Business Name): ATHOL PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 05/31/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MAIN ST
ATHOL MA
01331-2226
US

IV. Provider business mailing address

290 MAIN ST
ATHOL MA
01331-2226
US

V. Phone/Fax

Practice location:
  • Phone: 978-830-0427
  • Fax: 978-830-0430
Mailing address:
  • Phone: 978-830-0427
  • Fax: 978-830-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberDS90085
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MACNEILL
Title or Position: PRESIDENT
Credential: RPH
Phone: 978-830-0427