Provider Demographics
NPI:1407952831
Name:CAPE ANN STORES INC
Entity Type:Organization
Organization Name:CAPE ANN STORES INC
Other - Org Name:ALLENS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-526-1321
Mailing Address - Street 1:40 BEACH ST
Mailing Address - Street 2:UNIT G
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1468
Mailing Address - Country:US
Mailing Address - Phone:978-526-1321
Mailing Address - Fax:978-526-1190
Practice Address - Street 1:40 BEACH ST
Practice Address - Street 2:UNIT G
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1468
Practice Address - Country:US
Practice Address - Phone:978-526-1321
Practice Address - Fax:978-526-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MA25203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2039139OtherPK
MA0447064Medicaid
MA0423882Medicaid