Provider Demographics
NPI:1801253489
Name:DEDHAM PHARMACY & MEDICAL SUPPLY
Entity type:Organization
Organization Name:DEDHAM PHARMACY & MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:781-326-7007
Mailing Address - Street 1:596 PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6804
Mailing Address - Country:US
Mailing Address - Phone:781-326-7007
Mailing Address - Fax:781-326-7006
Practice Address - Street 1:596 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6804
Practice Address - Country:US
Practice Address - Phone:781-326-7007
Practice Address - Fax:781-326-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy