=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083413264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNION PHARMACY STORE 6
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2025
-----------------------------------------------------
Last Update Date | 06/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 LEONARD ST
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02478-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-394-1025
-----------------------------------------------------
Fax | 857-394-1026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 LEONARD ST
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02478-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-394-1025
-----------------------------------------------------
Fax | 857-394-1026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RPH
-----------------------------------------------------
Name | XIAOYAN QIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-304-7477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------