Healthcare Provider Details

I. General information

NPI: 1659243541
Provider Name (Legal Business Name): BOOM STORES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OLD ANDOVER RD
NORTH READING MA
01864-1000
US

IV. Provider business mailing address

17 OLD ANDOVER RD
NORTH READING MA
01864-1000
US

V. Phone/Fax

Practice location:
  • Phone: 781-970-3020
  • Fax:
Mailing address:
  • Phone: 781-970-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: GULNAZ SARFARAZ
Title or Position: MANAGER
Credential:
Phone: 781-970-3020