Provider Demographics
NPI:1457523201
Name:NORTHEAST CMOP
Entity Type:Organization
Organization Name:NORTHEAST CMOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPER.MGR.-RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BARROS
Authorized Official - Suffix:JR
Authorized Official - Credentials:BSP
Authorized Official - Phone:978-244-1300
Mailing Address - Street 1:10 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3610
Mailing Address - Country:US
Mailing Address - Phone:978-244-1300
Mailing Address - Fax:
Practice Address - Street 1:10 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3610
Practice Address - Country:US
Practice Address - Phone:978-244-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17396332100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy