Healthcare Provider Details

I. General information

NPI: 1598828980
Provider Name (Legal Business Name): MEDICINE STORE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 LOWELL ST
WAKEFIELD MA
01880-1962
US

IV. Provider business mailing address

409 LOWELL ST
WAKEFIELD MA
01880-1962
US

V. Phone/Fax

Practice location:
  • Phone: 781-246-3527
  • Fax: 781-246-8542
Mailing address:
  • Phone: 781-246-3527
  • Fax: 781-246-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3372
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number3372
License Number StateMA

VIII. Authorized Official

Name: MR. MICHAEL CARPINELLA
Title or Position: OWNER
Credential: RPH
Phone: 781-246-3527