Healthcare Provider Details

I. General information

NPI: 1407952831
Provider Name (Legal Business Name): CAPE ANN STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BEACH ST UNIT G
MANCHESTER MA
01944-1468
US

IV. Provider business mailing address

40 BEACH ST UNIT G
MANCHESTER MA
01944-1468
US

V. Phone/Fax

Practice location:
  • Phone: 978-526-1321
  • Fax: 978-526-1190
Mailing address:
  • Phone: 978-526-1321
  • Fax: 978-526-1190

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 Number2520
License Number StateMA

VIII. Authorized Official

Name: JAY SIBULKIN
Title or Position: PRESIDENT
Credential:
Phone: 978-526-1321