Provider Demographics
NPI:1669473542
Name:KAY-JAY PHARMACY,INC
Entity type:Organization
Organization Name:KAY-JAY PHARMACY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-743-5702
Mailing Address - Street 1:17 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1858
Mailing Address - Country:US
Mailing Address - Phone:413-743-5702
Mailing Address - Fax:413-743-0710
Practice Address - Street 1:17 DEPOT ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1858
Practice Address - Country:US
Practice Address - Phone:413-743-5702
Practice Address - Fax:413-743-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22759333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0427209Medicaid
2222759OtherNCPDP NUMBER
2222759OtherNCPDP NUMBER