Healthcare Provider Details

I. General information

NPI: 1942513635
Provider Name (Legal Business Name): CONROY APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 PENNACOOK AVE.
OAK BLUFFS MA
02557
US

IV. Provider business mailing address

PO BOX 3349 82 PENNACOOK AVE
OAK BLUFFS MA
02557-3349
US

V. Phone/Fax

Practice location:
  • Phone: 508-696-0700
  • Fax: 508-687-9541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberDS89729
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAMARA HERSH
Title or Position: PRESIDENT
Credential:
Phone: 508-693-7070