Provider Demographics
NPI:1790170231
Name:NOSTRUM THERAPY MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:NOSTRUM THERAPY MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:U
Authorized Official - Last Name:BANDEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-797-4842
Mailing Address - Street 1:22 BASSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-1604
Mailing Address - Country:US
Mailing Address - Phone:617-797-4842
Mailing Address - Fax:
Practice Address - Street 1:22 BASSWOOD AVE
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-1604
Practice Address - Country:US
Practice Address - Phone:617-797-4842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty