Provider Demographics
NPI:1730489493
Name:CHELSEA PHARM INC
Entity Type:Organization
Organization Name:CHELSEA PHARM INC
Other - Org Name:MARGOLIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:URIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-405-3228
Mailing Address - Street 1:447 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2809
Mailing Address - Country:US
Mailing Address - Phone:617-884-3524
Mailing Address - Fax:617-889-3395
Practice Address - Street 1:447 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2809
Practice Address - Country:US
Practice Address - Phone:617-884-3524
Practice Address - Fax:617-889-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MADS897443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2243373OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MA6495700001Medicare NSC