Provider Demographics
NPI:1245429729
Name:DUVALS PHARMACY STORE 2 INC
Entity type:Organization
Organization Name:DUVALS PHARMACY STORE 2 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANG
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-350-2900
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-0429
Mailing Address - Country:US
Mailing Address - Phone:781-447-0608
Mailing Address - Fax:781-447-0876
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:STE 101
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1465
Practice Address - Country:US
Practice Address - Phone:508-350-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
MADS35543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2242117OtherNCPDP PROVIDER IDENTIFICATION NUMBER