Healthcare Provider Details

I. General information

NPI: 1639239346
Provider Name (Legal Business Name): CONROY APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 STATE RD.
WEST TISBURY MA
02575-0422
US

IV. Provider business mailing address

PO BOX 422
WEST TISBURY MA
02575-0422
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-7070
  • Fax: 508-693-7071
Mailing address:
  • Phone: 508-693-7070
  • Fax: 508-693-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1656
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1656
License Number StateMA

VIII. Authorized Official

Name: MRS. TAMARA HERSH
Title or Position: PRESIDENT
Credential: RPH
Phone: 508-693-4558