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General NPI Number Information
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NPI Number | 1326174350
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Entity Type | Organization
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Legal Business Name | TEAMSTERS UNION 25 HEALTH SERVICES AND INSURANCE PLAN
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1214 PARK ST
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City | STOUGHTON
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State | MA
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Zip | 02072-3738
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Country | US
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Telephone | 781-297-9764
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Fax | 781-297-9370
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Provider Business Mailing Address
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Address Line | 1214 PARK ST
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City | STOUGHTON
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State | MA
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Zip | 02072-3738
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Country | US
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Telephone | 781-297-9764
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Fax | 781-297-9370
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. WILLIAM JOSEPH YAMARTINO
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Credential | R.PH
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Telephone | 781-297-9764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 2919
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License Number State | MA
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