Provider Demographics
NPI:1245611151
Name:TARGET PHARMACY
Entity Type:Organization
Organization Name:TARGET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHENAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:MULU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:617-763-1910
Mailing Address - Street 1:8 SAINT CASIMIR ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 SAINT CASIMIR ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2121
Practice Address - Country:US
Practice Address - Phone:617-763-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty