Provider Demographics
NPI:1447399225
Name:FAMILY HEALTH CENTER OF WORCESTER, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF WORCESTER, INC.
Other - Org Name:FHCW, INC-PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR. PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ALYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTINIANO-FRANZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-860-7730
Mailing Address - Street 1:26 QUEEN ST
Mailing Address - Street 2:PHARMACY
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7962
Mailing Address - Fax:508-860-7929
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:PHARMACY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7962
Practice Address - Fax:508-860-7929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CENTER OF WORCESTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA401333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5650880001Medicare NSC