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General NPI Number Information
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NPI Number | 1205853223
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Entity Type | Organization
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Legal Business Name | SUPERPHARM, INC.
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 7 WILLOW ST
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City | LYNN
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State | MA
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Zip | 01901-1206
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Country | US
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Telephone | 781-599-5900
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Fax | 781-599-5918
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Provider Business Mailing Address
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Address Line | 7 WILLOW ST
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City | LYNN
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State | MA
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Zip | 01901-1206
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Country | US
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Telephone | 781-599-5900
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Fax | 781-599-5918
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. OLEG URIM
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Credential | RPH
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Telephone | 781-599-5900
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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 | 3466
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License Number State | MA
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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 | 3466
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License Number State | MA
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