Healthcare Provider Details

I. General information

NPI: 1407942667
Provider Name (Legal Business Name): GRANBY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 STATE ST
GRANBY MA
01033-9417
US

IV. Provider business mailing address

242 STATE ST
GRANBY MA
01033-9417
US

V. Phone/Fax

Practice location:
  • Phone: 413-467-7022
  • Fax: 413-467-3773
Mailing address:
  • Phone: 413-467-7022
  • Fax: 413-467-3773

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 Number2730
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number2730
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2730
License Number StateMA

VIII. Authorized Official

Name: MR. LEE A. LALONDE
Title or Position: OWNER
Credential: RPH
Phone: 413-467-7022