Provider Demographics
NPI:1821215922
Name:MARYESTHER INC
Entity Type:Organization
Organization Name:MARYESTHER INC
Other - Org Name:SMITH DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARYESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:BS RPH
Authorized Official - Phone:781-245-0380
Mailing Address - Street 1:390 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5015
Mailing Address - Country:US
Mailing Address - Phone:781-245-0380
Mailing Address - Fax:781-245-1350
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5015
Practice Address - Country:US
Practice Address - Phone:781-245-0380
Practice Address - Fax:781-245-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MA21983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0413917Medicaid
2037242OtherPK
2037242OtherPK
0463130001Medicare NSC