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General NPI Number Information
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NPI Number | 1811255417
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Entity Type | Organization
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Legal Business Name | CITY DRUG INC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 22 STATE ST
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City | LYNN
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State | MA
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Zip | 01901-1505
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Country | US
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Telephone | 781-599-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 22 STATE ST
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City | LYNN
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State | MA
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Zip | 01901-1505
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Country | US
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Telephone | 781-599-0900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLEG URIM
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Credential | BS PHARM
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Telephone | 781-405-3228
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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 | DS89810
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License Number State | MA
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