Provider Demographics
NPI:1982760351
Name:CARITAS ST. ELIZABETH'S MEDICAL CENTER
Entity Type:Organization
Organization Name:CARITAS ST. ELIZABETH'S MEDICAL CENTER
Other - Org Name:BRIGHTON MARINE HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GERMANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-562-5302
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-562-5302
Mailing Address - Fax:617-562-5296
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-562-5302
Practice Address - Fax:617-562-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABB4261575261Q00000X
MABB3797113261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0401200Medicaid