Provider Demographics
NPI:1407942667
Name:GRANBY PHARMACY, INC.
Entity Type:Organization
Organization Name:GRANBY PHARMACY, INC.
Other - Org Name:CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LALONDE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:413-467-7022
Mailing Address - Street 1:242 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9417
Mailing Address - Country:US
Mailing Address - Phone:413-467-7022
Mailing Address - Fax:413-467-3773
Practice Address - Street 1:242 STATE ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MA
Practice Address - Zip Code:01033-9417
Practice Address - Country:US
Practice Address - Phone:413-467-7022
Practice Address - Fax:413-467-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA27303336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1182810001Medicare ID - Type Unspecified