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General NPI Number Information
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NPI Number | 1205532090
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Entity Type | Organization
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Legal Business Name | SOUTHCOAST HOSPITALS GROUP INC
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 206 MILL RD SOUTHCOAST SPECIALTY PHARMACY
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City | FAIRHAVEN
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State | MA
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Zip | 02719
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Country | US
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Telephone | 508-973-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 101 PAGE ST SOUTHCOAST PHARMACY
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City | NEW BEDFORD
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State | MA
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Zip | 02740-3464
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Country | US
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Telephone | 508-973-5760
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Fax |
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Authorized Official
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Title or Position | EVP - CHIEF FINANCIAL OFFICER
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Name | WADE DUDLEY BROUGHMAN
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Credential |
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Telephone | 508-973-2908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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