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General NPI Number Information
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NPI Number | 1598858938
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Entity Type | Organization
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Legal Business Name | ATHOL FAMILY PHARMACY INCORPORATED
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 321 MAIN ST
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City | ATHOL
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State | MA
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Zip | 01331-2233
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Country | US
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Telephone | 978-249-9100
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Fax | 978-249-9199
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Provider Business Mailing Address
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Address Line | 100 GROVE ST SUITE 201
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City | WORCESTER
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State | MA
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Zip | 01605-2627
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Country | US
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Telephone | 508-755-4173
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Fax | 508-755-4173
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAMID MOHAGHEGH
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Credential |
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Telephone | 508-755-4173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | DS3480
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License Number State | MA
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