Provider Demographics
NPI:1609985746
Name:MCNABB PHARMACY
Entity Type:Organization
Organization Name:MCNABB PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNABB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:978-597-2392
Mailing Address - Street 1:233 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469-1033
Mailing Address - Country:US
Mailing Address - Phone:978-597-2392
Mailing Address - Fax:978-597-8731
Practice Address - Street 1:233 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01469-1033
Practice Address - Country:US
Practice Address - Phone:978-597-2392
Practice Address - Fax:978-597-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA138993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA409812Medicaid
MA0778850001Medicare NSC