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General NPI Number Information
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NPI Number | 1821379298
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Entity Type | Organization
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Legal Business Name | MOMS PHARMACY, INC.
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 75 AMORY ST
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City | ROXBURY
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State | MA
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Zip | 02119-1051
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Country | US
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Telephone | 617-708-3922
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Fax | 617-708-3999
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Provider Business Mailing Address
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Address Line | 75 AMORY ST
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City | ROXBURY
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State | MA
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Zip | 02119-1051
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Country | US
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Telephone | 617-708-3922
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Fax | 617-708-3999
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | GLENN SCHABEL
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Credential | R.PH.
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Telephone | 631-870-5129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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