Provider Demographics
NPI:1982465902
Name:DOYLES CORNER DRUG INC
Entity Type:Organization
Organization Name:DOYLES CORNER DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:978-356-2121
Mailing Address - Street 1:146 HIGH ST UNIT H
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1212
Mailing Address - Country:US
Mailing Address - Phone:978-356-2121
Mailing Address - Fax:978-356-7173
Practice Address - Street 1:146 HIGH ST UNIT H
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1212
Practice Address - Country:US
Practice Address - Phone:978-356-2121
Practice Address - Fax:978-356-7173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOYLES CORNER DRUG INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADS2654OtherSTATE LICENSE
MA11021666AMedicaid