Healthcare Provider Details

I. General information

NPI: 1033722830
Provider Name (Legal Business Name): A&J ETHOS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CABOT RD
WOBURN MA
01801-1004
US

IV. Provider business mailing address

577 MAIN ST
WALTHAM MA
02452-5527
US

V. Phone/Fax

Practice location:
  • Phone: 855-509-8222
  • Fax: 781-897-6937
Mailing address:
  • Phone: 781-893-3870
  • Fax: 781-899-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREW STEIN
Title or Position: CO-OWNER
Credential: RPH, PHARMD
Phone: 781-893-3870