Provider Demographics
NPI:1275815185
Name:WLAGREENS PHARMACY
Entity Type:Organization
Organization Name:WLAGREENS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PIERONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-286-1659
Mailing Address - Street 1:43 MILANO AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-2127
Mailing Address - Country:US
Mailing Address - Phone:781-286-1659
Mailing Address - Fax:
Practice Address - Street 1:43 MILANO AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-2127
Practice Address - Country:US
Practice Address - Phone:781-286-1659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty