Provider Demographics
NPI:1154863835
Name:HEALTH CARE FAMILY PHARMACY
Entity Type:Organization
Organization Name:HEALTH CARE FAMILY PHARMACY
Other - Org Name:HEALTH CARE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:SOTERIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANTZIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-523-7127
Mailing Address - Street 1:14 LOON HILL RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4015
Mailing Address - Country:US
Mailing Address - Phone:978-455-0570
Mailing Address - Fax:978-455-6921
Practice Address - Street 1:14 LOON HILL RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4015
Practice Address - Country:US
Practice Address - Phone:978-455-0570
Practice Address - Fax:978-455-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MADS900653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166259OtherPK