Provider Demographics
NPI:1639225899
Name:PRESCRIPTION SHOPPE INC
Entity Type:Organization
Organization Name:PRESCRIPTION SHOPPE INC
Other - Org Name:PRESCRIPTION SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VASHKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-240-0271
Mailing Address - Street 1:378 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3426
Mailing Address - Country:US
Mailing Address - Phone:617-389-7440
Mailing Address - Fax:617-389-1004
Practice Address - Street 1:378 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3426
Practice Address - Country:US
Practice Address - Phone:617-389-7440
Practice Address - Fax:617-389-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS66543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0407151Medicaid
2135268OtherPK