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General NPI Number Information
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NPI Number | 1275815185
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Entity Type | Organization
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Legal Business Name | WLAGREENS PHARMACY
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 43 MILANO AVE
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City | REVERE
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State | MA
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Zip | 02151-2127
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Country | US
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Telephone | 781-286-1659
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Fax |
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Provider Business Mailing Address
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Address Line | 43 MILANO AVE
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City | REVERE
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State | MA
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Zip | 02151-2127
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Country | US
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Telephone | 781-286-1659
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Fax |
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | MR. MICHAEL EDWARD PIERONI
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Credential |
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Telephone | 781-286-1659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21622
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License Number State | MA
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