MEDICARE: BETH ISRAEL LAHEY HEALTH PHARMACY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DS90335	OTHER	MA	MASSACHUSETTS DRUG STORE PERMIT ID

General Provider Information

NPI Number	:	1306567938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETH ISRAEL LAHEY HEALTH PHARMACY, INC

Provider Business Mailing Address
First Line	:	80 WILSON WAY STE B
Second Line	:
City	:	WESTWOOD
State	:	MA
Zip	:	02090-1806
Country	:	US
Telephone Number	:	781-352-6504
Fax Number	:	781-352-6610

Provider Business Practice Location Address
First Line	:	80 WILSON WAY STE B
Second Line	:
City	:	WESTWOOD
State	:	MA
Zip	:	02090-1806
Country	:	US
Telephone Number	:	781-352-6600
Fax Number	:	781-352-6610

Authorized Official
Title or Position	:	DIRECTOR SPECIALTY PHARMACY
Name	:	MR. LUCA CATTANEO
Credential	:
Telephone Number	:	781-352-6504

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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