Provider Demographics
NPI:1861440679
Name:CHELMSFORD VA CMOP
Entity Type:Organization
Organization Name:CHELMSFORD VA CMOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF CONSULTANT PBM/CMOP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEHR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MPA
Authorized Official - Phone:913-758-4750
Mailing Address - Street 1:10 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3610
Mailing Address - Country:US
Mailing Address - Phone:978-244-1300
Mailing Address - Fax:978-244-1302
Practice Address - Street 1:10 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3610
Practice Address - Country:US
Practice Address - Phone:978-244-1313
Practice Address - Fax:978-244-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2241165OtherNCPDP#
MABC4110475OtherDEA#