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General NPI Number Information
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NPI Number | 1891803060
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Entity Type | Organization
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Legal Business Name | WILLOW PHARMACY
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 280 UNION ST
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City | LYNN
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State | MA
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Zip | 01901-1353
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Country | US
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Telephone | 781-592-4350
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Fax | 781-268-0662
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Provider Business Mailing Address
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Address Line | 280 UNION ST
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City | LYNN
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State | MA
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Zip | 01901-1353
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Country | US
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Telephone | 781-592-4350
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Fax | 781-268-0662
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN STRASNICK
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Credential |
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Telephone | 781-592-4350
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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 | 3283
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License Number State | MA
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