Provider Demographics
NPI:1023562006
Name:PRESCOTT PHARMACY LTC INC
Entity Type:Organization
Organization Name:PRESCOTT PHARMACY LTC INC
Other - Org Name:PRESCOTT PHARMACY LTC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:BUFFUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-683-0260
Mailing Address - Street 1:100 GROVE ST STE B12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2630
Mailing Address - Country:US
Mailing Address - Phone:508-683-0260
Mailing Address - Fax:508-683-0270
Practice Address - Street 1:100 GROVE ST STE B12
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2630
Practice Address - Country:US
Practice Address - Phone:508-683-0260
Practice Address - Fax:508-683-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS900513336L0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162515OtherPK