Provider Demographics
NPI:1740615574
Name:GALAXY PHARMACY LLC
Entity Type:Organization
Organization Name:GALAXY PHARMACY LLC
Other - Org Name:GALAXY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-268-0800
Mailing Address - Street 1:534 DORCHESTER AVE
Mailing Address - Street 2:UNIT C-1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2762
Mailing Address - Country:US
Mailing Address - Phone:617-268-0800
Mailing Address - Fax:
Practice Address - Street 1:534 DORCHESTER AVE UNIT C-1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2762
Practice Address - Country:US
Practice Address - Phone:617-268-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS898983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142194OtherPK