Provider Demographics
NPI:1083942460
Name:AIRLINE DRUG INC
Entity Type:Organization
Organization Name:AIRLINE DRUG INC
Other - Org Name:LOUIS AND CLARK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:413-596-2431
Mailing Address - Street 1:309 EAST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2259
Mailing Address - Country:US
Mailing Address - Phone:413-285-8504
Mailing Address - Fax:413-737-3814
Practice Address - Street 1:238 NORTHAMPTON STREET
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1046
Practice Address - Country:US
Practice Address - Phone:413-596-2431
Practice Address - Fax:413-596-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA897013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0460090005Medicare NSC