Provider Demographics
NPI:1760804397
Name:SEASIDE PHARMACY INC.
Entity Type:Organization
Organization Name:SEASIDE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TU-ANH
Authorized Official - Middle Name:THI
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:781-284-6525
Mailing Address - Street 1:169 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3256
Mailing Address - Country:US
Mailing Address - Phone:781-284-6525
Mailing Address - Fax:781-284-6530
Practice Address - Street 1:169 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3256
Practice Address - Country:US
Practice Address - Phone:781-284-6525
Practice Address - Fax:781-284-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy