Healthcare Provider Details

I. General information

NPI: 1629122072
Provider Name (Legal Business Name): NANTASKET PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 NANTASKET AVE
HULL MA
02045-2521
US

IV. Provider business mailing address

480 NANTASKET AVE
HULL MA
02045-2521
US

V. Phone/Fax

Practice location:
  • Phone: 781-925-1270
  • Fax: 781-925-0551
Mailing address:
  • Phone: 781-925-1270
  • Fax: 781-925-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS2038
License Number StateMA

VIII. Authorized Official

Name: ROCKY TENUGLIA
Title or Position: PRESIDENT
Credential: RPH
Phone: 781-925-2378