Healthcare Provider Details

I. General information

NPI: 1093814600
Provider Name (Legal Business Name): INMAN PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/07/2023
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 CAMBRIDGE STREET
CAMBRIDGE MA
02139
US

IV. Provider business mailing address

1414 CAMBRIDGE STREET
CAMBRIDGE MA
02139
US

V. Phone/Fax

Practice location:
  • Phone: 617-876-4868
  • Fax: 617-547-9521
Mailing address:
  • Phone: 617-876-4868
  • Fax: 617-547-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1111
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL FRANCIS REPPUCCI
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 617-876-4867