Provider Demographics
NPI:1083051205
Name:PARTNERS OF MASSACHUSETTS LLC
Entity Type:Organization
Organization Name:PARTNERS OF MASSACHUSETTS LLC
Other - Org Name:DIVERSIFIED SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-931-9111
Mailing Address - Street 1:1451 CONCORD ST
Mailing Address - Street 2:STE 6
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7782
Mailing Address - Country:US
Mailing Address - Phone:508-877-0080
Mailing Address - Fax:866-728-9091
Practice Address - Street 1:1451 CONCORD ST
Practice Address - Street 2:STE 6
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7782
Practice Address - Country:US
Practice Address - Phone:508-877-0080
Practice Address - Fax:866-728-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS898713336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140980OtherPK
2140980OtherPK