MEDICARE: WILLIAMSBURG 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	3336C0003X	Community/Retail Pharmacy	2509	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689763773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSBURG PHARMACY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 397
Second Line	:
City	:	WILLIAMSBURG
State	:	MA
Zip	:	01096-0397
Country	:	US
Telephone Number	:	413-268-3387
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 MAIN STREET
Second Line	:
City	:	WILLIAMSBURG
State	:	MA
Zip	:	01096
Country	:	US
Telephone Number	:	413-268-3387
Fax Number	:	413-268-7391

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GREGORY R CONZ
Credential	:	R.PH.
Telephone Number	:	413-268-3387

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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Directions to “WILLIAMSBURG PHARMACY, INC. ” Practice Location

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