Provider Demographics
NPI:1912149493
Name:MONA PHARMACY CORP
Entity Type:Organization
Organization Name:MONA PHARMACY CORP
Other - Org Name:CENTRAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETAREY
Authorized Official - Prefix:
Authorized Official - First Name:DIPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-254-5900
Mailing Address - Street 1:1349 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3301
Mailing Address - Country:US
Mailing Address - Phone:617-254-5900
Mailing Address - Fax:617-254-5908
Practice Address - Street 1:1349 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-3301
Practice Address - Country:US
Practice Address - Phone:617-254-5900
Practice Address - Fax:617-254-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS89966333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152541OtherPK
MA110104358AMedicaid