Provider Demographics
NPI:1972081594
Name:BETH ISRAEL LAHEY HEALTH PHARMACY, INC
Entity Type:Organization
Organization Name:BETH ISRAEL LAHEY HEALTH PHARMACY, INC
Other - Org Name:BILH PHARMACY 67 S BEDFORD ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:PUNGITORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-352-6533
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-5077
Mailing Address - Fax:
Practice Address - Street 1:67 S BEDFORD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5108
Practice Address - Country:US
Practice Address - Phone:781-744-8058
Practice Address - Fax:781-744-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0419222Medicaid