Provider Demographics
NPI:1053471268
Name:MEETINGHOUSE COMMUNITY PHARMACY, INC.
Entity Type:Organization
Organization Name:MEETINGHOUSE COMMUNITY PHARMACY, INC.
Other - Org Name:MEETINGHOUSE COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BALDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IHENACHO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-436-1120
Mailing Address - Street 1:248 BOWDOIN STREET
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122
Mailing Address - Country:US
Mailing Address - Phone:617-436-1120
Mailing Address - Fax:617-436-1140
Practice Address - Street 1:248 BOWDOIN STREET
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-436-1120
Practice Address - Fax:617-436-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA23133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0441716Medicaid