Healthcare Provider Details

I. General information

NPI: 1073900577
Provider Name (Legal Business Name): PHARMBLUE MASSACHUSETTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 PLEASANT ST
ATTLEBORO MA
02703-2457
US

IV. Provider business mailing address

5700 GRANITE PKWY STE 425
PLANO TX
75024-6648
US

V. Phone/Fax

Practice location:
  • Phone: 855-779-4720
  • Fax:
Mailing address:
  • Phone: 469-592-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN GURLEY
Title or Position: VP LEGAL AFFAIRS
Credential:
Phone: 469-592-2011