Provider Demographics
NPI:1891865812
Name:SPECTOR DRUG INC
Entity Type:Organization
Organization Name:SPECTOR DRUG INC
Other - Org Name:SPECTOR DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHRM OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-592-3179
Mailing Address - Street 1:289 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-2330
Mailing Address - Country:US
Mailing Address - Phone:781-592-3179
Mailing Address - Fax:781-592-1046
Practice Address - Street 1:289 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-2330
Practice Address - Country:US
Practice Address - Phone:781-592-3179
Practice Address - Fax:781-592-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MADS93713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0414042Medicaid
2209371OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MA0414042Medicaid