Healthcare Provider Details

I. General information

NPI: 1083942460
Provider Name (Legal Business Name): AIRLINE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 NORTHAMPTON STREET
EASTHAMPTON MA
01027-1046
US

IV. Provider business mailing address

309 EAST ST
SPRINGFIELD MA
01104-2259
US

V. Phone/Fax

Practice location:
  • Phone: 413-596-2431
  • Fax: 413-596-2966
Mailing address:
  • Phone: 413-285-8504
  • Fax: 413-737-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number89701
License Number StateMA

VIII. Authorized Official

Name: MR. CLARK E MATTHEWS JR.
Title or Position: PRESIDENT
Credential:
Phone: 413-596-2431