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NPI Code Detail

MEDICARE: MARTHA SUE LUNDGREN

MEDICARE: MARTHA SUE LUNDGREN
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
1183500000XPharmacistPH22464MA

General Provider Information

NPI Number : 1912209958
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA SUE LUNDGREN
Provider Business Mailing Address
First Line : 100 POWDERMILL RD
Second Line :
City : ACTON
State : MA
Zip : 01720-5932
Country : US
Telephone Number : 781-257-5101
Fax Number :
Provider Business Practice Location Address
First Line : 100 POWDERMILL RD
Second Line :
City : ACTON
State : MA
Zip : 01720-5932
Country : US
Telephone Number : 978-897-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2010
Last Update Date : 10/02/2012

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Directions to “ MARTHA SUE LUNDGREN ” Practice Location

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