Provider Demographics
NPI:1255892030
Name:SUPERPHARM, INC.
Entity type:Organization
Organization Name:SUPERPHARM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:URIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-599-5900
Mailing Address - Street 1:7 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1206
Mailing Address - Country:US
Mailing Address - Phone:781-599-5900
Mailing Address - Fax:
Practice Address - Street 1:7 WILLOW ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1206
Practice Address - Country:US
Practice Address - Phone:781-599-5900
Practice Address - Fax:781-599-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy