Provider Demographics
NPI:1831651272
Name:WALSH PHARMACY OF ROCK STREET INC
Entity Type:Organization
Organization Name:WALSH PHARMACY OF ROCK STREET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER, R.PH.
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTERNAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-679-1300
Mailing Address - Street 1:202 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3212
Mailing Address - Country:US
Mailing Address - Phone:508-679-1300
Mailing Address - Fax:
Practice Address - Street 1:202 ROCK ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3212
Practice Address - Country:US
Practice Address - Phone:508-679-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALSH PHARMACY OF ROCK STREET INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1035808Medicaid
RIWP03910Medicaid
MA0428671Medicaid