Provider Demographics
NPI:1629111554
Name:BROWN'S REXALL DRUG STORE
Entity Type:Organization
Organization Name:BROWN'S REXALL DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OFILOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-846-1500
Mailing Address - Street 1:214 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2605
Mailing Address - Country:US
Mailing Address - Phone:617-846-1500
Mailing Address - Fax:617-539-1611
Practice Address - Street 1:214 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2605
Practice Address - Country:US
Practice Address - Phone:617-846-1500
Practice Address - Fax:617-539-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0431168Medicaid