Provider Demographics
NPI:1003412933
Name:PHARMA SERVICE LLC
Entity Type:Organization
Organization Name:PHARMA SERVICE LLC
Other - Org Name:ETERNA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-817-5044
Mailing Address - Street 1:PO BOX 2007
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02741-2007
Mailing Address - Country:US
Mailing Address - Phone:508-817-5044
Mailing Address - Fax:774-305-4011
Practice Address - Street 1:1183 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-1905
Practice Address - Country:US
Practice Address - Phone:508-817-5044
Practice Address - Fax:774-305-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110148332AMedicaid