Provider Demographics
NPI:1619089745
Name:FAMILY PHARMACY LOCATED AT HEYWOOD HOSPITAL, INC.
Entity Type:Organization
Organization Name:FAMILY PHARMACY LOCATED AT HEYWOOD HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAGHEGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MS, MHA
Authorized Official - Phone:508-755-4173
Mailing Address - Street 1:100 GROVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2627
Mailing Address - Country:US
Mailing Address - Phone:508-755-4173
Mailing Address - Fax:508-755-4524
Practice Address - Street 1:250 GREEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1396
Practice Address - Country:US
Practice Address - Phone:978-632-4533
Practice Address - Fax:978-632-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2963332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2237421OtherNCPDP PROVIDER ID NUMBER
MA2237421OtherNCPDP PROVIDER ID NUMBER