Provider Demographics
NPI:1356841662
Name:PHARMACEUTICALLY ELEGANT INC
Entity type:Organization
Organization Name:PHARMACEUTICALLY ELEGANT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMBREFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-334-3133
Mailing Address - Street 1:590 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1712
Mailing Address - Country:US
Mailing Address - Phone:781-334-3133
Mailing Address - Fax:781-334-3838
Practice Address - Street 1:590 MAIN ST
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-1712
Practice Address - Country:US
Practice Address - Phone:781-334-3133
Practice Address - Fax:781-334-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS29403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy