Healthcare Provider Details

I. General information

NPI: 1275545857
Provider Name (Legal Business Name): SHORE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 HIGH ST
MEDFORD MA
02155-3632
US

IV. Provider business mailing address

429 HIGH ST
MEDFORD MA
02155-3632
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-4420
  • Fax: 781-379-2962
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2621
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2621
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PASQUARIELLO
Title or Position: OWNER
Credential:
Phone: 781-395-4420