1619089745 NPI number — FAMILY PHARMACY LOCATED AT HEYWOOD HOSPITAL, INC.

Table of content: (NPI 1619089745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619089745 NPI number — FAMILY PHARMACY LOCATED AT HEYWOOD HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHARMACY LOCATED AT HEYWOOD HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619089745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 GROVE ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605-2627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-755-4173
Provider Business Mailing Address Fax Number:
508-755-4524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 GREEN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GARDNER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01440-1396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-632-4533
Provider Business Practice Location Address Fax Number:
978-632-4692
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAGHEGH
Authorized Official First Name:
HAMID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
508-755-4173

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2963 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2237421 . This is a "NCPDP PROVIDER ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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