Provider Demographics
NPI:1598828980
Name:MEDICINE STORE INC.
Entity Type:Organization
Organization Name:MEDICINE STORE INC.
Other - Org Name:THE MEDICINE STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:781-246-3527
Mailing Address - Street 1:409 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1962
Mailing Address - Country:US
Mailing Address - Phone:781-246-3527
Mailing Address - Fax:781-246-8542
Practice Address - Street 1:409 LOWELL ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1962
Practice Address - Country:US
Practice Address - Phone:781-246-3527
Practice Address - Fax:781-246-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA33723336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0407011Medicaid
MA5367490001Medicare NSC