Provider Demographics
NPI:1093814600
Name:INMAN PHARMACY, INC
Entity Type:Organization
Organization Name:INMAN PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:REPPUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-876-4867
Mailing Address - Street 1:1414 CAMBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-876-4868
Mailing Address - Fax:617-547-9521
Practice Address - Street 1:1414 CAMBRIDGE STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-876-4868
Practice Address - Fax:617-547-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11113336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110021534AMedicaid
2201111OtherNABP
MA1111OtherSTATE PHARMACY NUMBER
MA1111OtherSTATE PHARMACY NUMBER
MA1111OtherSTATE PHARMACY NUMBER