Provider Demographics
NPI:1952472102
Name:WAREHAM PHARMACY INC
Entity Type:Organization
Organization Name:WAREHAM PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTRANT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SANASARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-295-7399
Mailing Address - Street 1:2400 CRANBERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1043
Mailing Address - Country:US
Mailing Address - Phone:508-295-7399
Mailing Address - Fax:508-295-6163
Practice Address - Street 1:2400 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1043
Practice Address - Country:US
Practice Address - Phone:508-295-7399
Practice Address - Fax:508-295-6163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0422622Medicaid
MA2216819OtherNCPDP
MA2216819OtherNCPDP
MA0525090001Medicare ID - Type UnspecifiedMEDICARE