Provider Demographics
NPI:1639272917
Name:ASHBURNHAM FAMILY PHARMACY, INC.
Entity Type:Organization
Organization Name:ASHBURNHAM FAMILY PHARMACY, 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 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHBURNHAM
Practice Address - State:MA
Practice Address - Zip Code:01430-1247
Practice Address - Country:US
Practice Address - Phone:978-827-6766
Practice Address - Fax:978-827-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2240492OtherNCPDP PROVIDER ID NUMBER
MA5494280001Medicare NSC