Provider Demographics
NPI:1417363516
Name:SPRINGFIELD FAMILY PHARMACY, INC
Entity Type:Organization
Organization Name:SPRINGFIELD FAMILY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:508-755-4173
Mailing Address - Street 1:175 CAREW ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-209-8043
Mailing Address - Fax:413-301-8493
Practice Address - Street 1:175 CAREW ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-209-8043
Practice Address - Fax:413-301-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS899253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy