Healthcare Provider Details

I. General information

NPI: 1417068560
Provider Name (Legal Business Name): BOORAS MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 ESSEX ST
LYNN MA
01902-1712
US

IV. Provider business mailing address

59 ESSEX ST
LYNN MA
01902-1712
US

V. Phone/Fax

Practice location:
  • Phone: 781-598-3501
  • Fax: 781-598-3552
Mailing address:
  • Phone: 781-598-3501
  • Fax: 781-598-3552

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9321
License Number StateMA

VIII. Authorized Official

Name: WILLIAMS BOORAS
Title or Position: OWNER AND PRES
Credential:
Phone: 781-598-3501