Healthcare Provider Details

I. General information

NPI: 1821170283
Provider Name (Legal Business Name): CONCORD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 MAIN ST
CONCORD MA
01742-3008
US

IV. Provider business mailing address

1212 MAIN ST
CONCORD MA
01742-3008
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-3100
  • Fax: 978-371-1613
Mailing address:
  • Phone: 978-369-3100
  • Fax: 978-371-1613

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3607
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAAD DINNO
Title or Position: OWNER
Credential: RPH
Phone: 978-369-3100