Provider Demographics
NPI: | 1659051795 |
---|---|
Name: | UPHAM'S CORNER HEALTH COMMITTEE, INC. |
Entity Type: | Organization |
Organization Name: | UPHAM'S CORNER HEALTH COMMITTEE, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAGDEEP |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TRIVEDI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 617-740-8131 |
Mailing Address - Street 1: | 500 COLUMBIA RD # MS 415-01 |
Mailing Address - Street 2: | |
Mailing Address - City: | DORCHESTER |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02125-2322 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-287-8000 |
Mailing Address - Fax: | 617-282-8625 |
Practice Address - Street 1: | 415 COLUMBIA RD |
Practice Address - Street 2: | |
Practice Address - City: | DORCHESTER |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02125-2424 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-287-8000 |
Practice Address - Fax: | 617-282-8625 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | UPHAM'S CORNER HEALTH COMMITTEE, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-07-24 |
Last Update Date: | 2023-07-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |