Provider Demographics
NPI:1134165749
Name:STAT-CARE PHARMACY, LLC
Entity type:Organization
Organization Name:STAT-CARE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:508-839-1221
Mailing Address - Street 1:198 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1578
Mailing Address - Country:US
Mailing Address - Phone:508-839-1221
Mailing Address - Fax:508-839-0097
Practice Address - Street 1:198 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1578
Practice Address - Country:US
Practice Address - Phone:508-839-1221
Practice Address - Fax:508-839-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27173336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2236708OtherNABP#
MA0445959Medicaid
MA2236708OtherNABP#