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General NPI Number Information
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NPI Number | 1992473805
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Entity Type | Organization
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Legal Business Name | EAST BAY PHARMACY CORP
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 1565 N MAIN ST STE 502
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City | FALL RIVER
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State | MA
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Zip | 02720-2972
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Country | US
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Telephone | 508-813-8623
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Fax |
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Provider Business Mailing Address
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Address Line | 1565 N MAIN ST STE 502
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City | FALL RIVER
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State | MA
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Zip | 02720-2972
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Country | US
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Telephone | 508-689-9320
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Fax | 508-689-9311
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEOFFREY PETERSON
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Credential | RPH
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Telephone | 508-813-8623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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