Healthcare Provider Details

I. General information

NPI: 1629404512
Provider Name (Legal Business Name): IVG HOSPITALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CABOT RD
WOBURN MA
01801-1004
US

IV. Provider business mailing address

20 CABOT RD
WOBURN MA
01801-1004
US

V. Phone/Fax

Practice location:
  • Phone: 781-897-6936
  • Fax: 781-897-6937
Mailing address:
  • Phone: 781-897-6936
  • Fax: 781-897-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberDS89887
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN MCDOWELL
Title or Position: PHARMACY MANAGER
Credential:
Phone: 781-897-6936