Provider Demographics
NPI:1477669547
Name:CIAMPA APOTHECARY
Entity Type:Organization
Organization Name:CIAMPA APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MTM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-547-0322
Mailing Address - Street 1:425 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1117
Mailing Address - Country:US
Mailing Address - Phone:617-547-0322
Mailing Address - Fax:617-497-4021
Practice Address - Street 1:425 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1117
Practice Address - Country:US
Practice Address - Phone:617-547-0322
Practice Address - Fax:617-497-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA9793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0402885Medicaid
MA5847500001Medicare ID - Type Unspecified
MA0402885Medicaid