Provider Demographics
NPI:1689361016
Name:BLUE HILL PHARMACY LTC
Entity Type:Organization
Organization Name:BLUE HILL PHARMACY LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-652-7546
Mailing Address - Street 1:320 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1951
Mailing Address - Country:US
Mailing Address - Phone:617-654-7546
Mailing Address - Fax:617-652-7561
Practice Address - Street 1:320 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1951
Practice Address - Country:US
Practice Address - Phone:617-654-7546
Practice Address - Fax:617-652-7561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NKANYIMUO REAL ESTATE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110102251AMedicaid