Healthcare Provider Details

I. General information

NPI: 1912006677
Provider Name (Legal Business Name): SHORX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 BELMONT ST
BELMONT MA
02478-3410
US

IV. Provider business mailing address

297 BELMONT ST
BELMONT MA
02478-3410
US

V. Phone/Fax

Practice location:
  • Phone: 617-484-7007
  • Fax: 617-484-7099
Mailing address:
  • Phone: 617-484-7007
  • Fax: 617-484-7099

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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1285
License Number StateMA

VIII. Authorized Official

Name: DANA SHORE
Title or Position: OWNER
Credential:
Phone: 617-484-7007