Provider Demographics
NPI:1801187117
Name:TINCHER, WALTER RICHARD JR (RPH)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:RICHARD
Last Name:TINCHER
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1905
Mailing Address - Country:US
Mailing Address - Phone:508-869-6581
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527
Practice Address - Country:US
Practice Address - Phone:508-865-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist