Healthcare Provider Details

I. General information

NPI: 1689763773
Provider Name (Legal Business Name): WILLIAMSBURG PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 MAIN STREET
WILLIAMSBURG MA
01096
US

IV. Provider business mailing address

PO BOX 397
WILLIAMSBURG MA
01096-0397
US

V. Phone/Fax

Practice location:
  • Phone: 413-268-3387
  • Fax: 413-268-7391
Mailing address:
  • Phone: 413-268-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2509
License Number StateMA

VIII. Authorized Official

Name: MR. GREGORY R CONZ
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 413-268-3387