Healthcare Provider Details

I. General information

NPI: 1730489493
Provider Name (Legal Business Name): CHELSEA PHARM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BROADWAY
CHELSEA MA
02150-2809
US

IV. Provider business mailing address

447 BROADWAY
CHELSEA MA
02150-2809
US

V. Phone/Fax

Practice location:
  • Phone: 617-884-3524
  • Fax: 617-889-3395
Mailing address:
  • Phone: 617-884-3524
  • Fax: 617-889-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS89744
License Number StateMA

VIII. Authorized Official

Name: OLEG URIM
Title or Position: MANAGER
Credential:
Phone: 781-405-3228