Healthcare Provider Details

I. General information

NPI: 1407164007
Provider Name (Legal Business Name): PRICE CHOPPER OPERATING CO OF MASS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 BOSTON TPKE
SHREWSBURY MA
01545-3201
US

IV. Provider business mailing address

461 NOTT ST MB#202
SCHENECTADY NY
12308-1812
US

V. Phone/Fax

Practice location:
  • Phone: 774-214-4255
  • Fax: 508-841-8100
Mailing address:
  • Phone: 518-379-1618
  • Fax: 518-356-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS89740
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN BRYANT
Title or Position: VP OF PHARMACY
Credential:
Phone: 518-379-1122