Healthcare Provider Details

I. General information

NPI: 1689957722
Provider Name (Legal Business Name): HRD CORP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HUMBOLDT AVE
DORCHESTER MA
02120
US

IV. Provider business mailing address

201 HUMBOLDT AVE
DORCHESTER MA
02120
US

V. Phone/Fax

Practice location:
  • Phone: 617-427-2222
  • Fax: 617-427-2205
Mailing address:
  • Phone: 617-427-2222
  • Fax: 617-427-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS89781
License Number StateMA

VIII. Authorized Official

Name: PAUL GARBARINI
Title or Position: ATTORNEY
Credential:
Phone: 413-727-8191