Provider Demographics
NPI:1790713378
Name:PHARMAHEALTH LONGTERM CARE INC
Entity Type:Organization
Organization Name:PHARMAHEALTH LONGTERM CARE INC
Other - Org Name:PHARMAHEALTH SPECIALTY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVARES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-998-8000
Mailing Address - Street 1:132 ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4721
Mailing Address - Country:US
Mailing Address - Phone:508-998-8000
Mailing Address - Fax:508-998-1145
Practice Address - Street 1:132 ALDEN RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4721
Practice Address - Country:US
Practice Address - Phone:508-998-8000
Practice Address - Fax:508-998-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 332B00000X
MADS897283336S0011X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2039567OtherPK
MA0408140Medicaid
5713360001Medicare NSC