Provider Demographics
NPI:1477623189
Name:COMMONWEALTH OF MASSACHUSETTS OFFICE FOR PHARMACY SERVICES
Entity Type:Organization
Organization Name:COMMONWEALTH OF MASSACHUSETTS OFFICE FOR PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF PHARMACY SERVIES
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:978-858-2114
Mailing Address - Street 1:369 EAST ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876
Mailing Address - Country:US
Mailing Address - Phone:978-858-2102
Mailing Address - Fax:978-858-2110
Practice Address - Street 1:369 EAST ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876
Practice Address - Country:US
Practice Address - Phone:978-858-2102
Practice Address - Fax:978-858-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22-38500OtherNABP#