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General NPI Number Information
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NPI Number | 1134238355
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Entity Type | Organization
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Legal Business Name | PAWTUCKET PHARMACY INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 65 SCHOOL ST
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City | LOWELL
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State | MA
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Zip | 01854-3239
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Country | US
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Telephone | 978-458-3366
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Fax | 978-454-5051
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Provider Business Mailing Address
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Address Line | 65 SCHOOL ST
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City | LOWELL
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State | MA
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Zip | 01854-3239
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Country | US
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Telephone | 978-458-3366
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Fax | 978-454-5051
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Authorized Official
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Title or Position | OWNER
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Name | BOB AUDET
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Credential |
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Telephone | 978-458-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 789
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License Number State | MA
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