Provider Demographics
NPI:1629104633
Name:TEAMSTERS UNION 25 HEALTH SERVICES AND INSURANCE PLAN
Entity Type:Organization
Organization Name:TEAMSTERS UNION 25 HEALTH SERVICES AND INSURANCE PLAN
Other - Org Name:TEAMSTERSCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:800-235-0760
Mailing Address - Street 1:552 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1109
Mailing Address - Country:US
Mailing Address - Phone:800-235-0760
Mailing Address - Fax:617-241-5025
Practice Address - Street 1:552 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1109
Practice Address - Country:US
Practice Address - Phone:800-235-0760
Practice Address - Fax:617-241-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2493305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service