=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447363999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH BERKSHIRE PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 09/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 ASHLAND ST
-----------------------------------------------------
City | NORTH ADAMS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01247-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-663-3711
-----------------------------------------------------
Fax | 413-664-9730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 778
-----------------------------------------------------
City | NORTH ADAMS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01247-0778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-663-3711
-----------------------------------------------------
Fax | 413-664-9730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GEN MANAGER
-----------------------------------------------------
Name | RICK CZARNECKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 413-663-3711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | DS2764
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------