Healthcare Provider Details

I. General information

NPI: 1932165131
Provider Name (Legal Business Name): AIRLINE DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DR
SPRINGFIELD MA
01107-1270
US

IV. Provider business mailing address

2689 BOSTON RD PO BOX 966
WILBRAHAM MA
01095-1141
US

V. Phone/Fax

Practice location:
  • Phone: 413-784-3455
  • Fax: 413-784-3589
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1563
License Number StateMA

VIII. Authorized Official

Name: CLARK MATTHEWS
Title or Position: PRESIDENT
Credential:
Phone: 413-596-2431