Provider Demographics
NPI:1467462804
Name:SKENDERIAN APOTHECARY
Entity Type:Organization
Organization Name:SKENDERIAN APOTHECARY
Other - Org Name:SKENDERIAN APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKENDERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-354-5600
Mailing Address - Street 1:1613 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4315
Mailing Address - Country:US
Mailing Address - Phone:617-354-5600
Mailing Address - Fax:617-492-8135
Practice Address - Street 1:1613 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4315
Practice Address - Country:US
Practice Address - Phone:617-354-5600
Practice Address - Fax:617-492-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MADS10583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2038476OtherPK
MA0496545Medicaid