Provider Demographics
NPI:1164432977
Name:BOYD'S PHARMACY OF MANSFIELD, INC
Entity Type:Organization
Organization Name:BOYD'S PHARMACY OF MANSFIELD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-298-7474
Mailing Address - Street 1:23202 COLUMBUS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1981
Mailing Address - Country:US
Mailing Address - Phone:609-298-7474
Mailing Address - Fax:609-298-6811
Practice Address - Street 1:23202 COLUMBUS RD
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1981
Practice Address - Country:US
Practice Address - Phone:609-298-7474
Practice Address - Fax:609-298-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4394101Medicaid
NJ3129485OtherNCPDP NUMBER
NJ3129485OtherNCPDP NUMBER