Provider Demographics
NPI:1326174350
Name:TEAMSTERS UNION 25 HEALTH SERVICES AND INSURANCE PLAN
Entity Type:Organization
Organization Name:TEAMSTERS UNION 25 HEALTH SERVICES AND INSURANCE PLAN
Other - Org Name:TEAMSTERS CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:YAMARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:781-297-9764
Mailing Address - Street 1:1214 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3738
Mailing Address - Country:US
Mailing Address - Phone:781-297-9764
Mailing Address - Fax:781-297-9370
Practice Address - Street 1:1214 PARK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3738
Practice Address - Country:US
Practice Address - Phone:781-297-9764
Practice Address - Fax:781-297-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2919305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service