Provider Demographics
NPI:1174049555
Name:PEPPERELL PHARMACY INC
Entity type:Organization
Organization Name:PEPPERELL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZZIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:978-433-6130
Mailing Address - Street 1:74 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1560
Mailing Address - Country:US
Mailing Address - Phone:978-433-6130
Mailing Address - Fax:978-433-1881
Practice Address - Street 1:74 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEPPERELL
Practice Address - State:MA
Practice Address - Zip Code:01463-1560
Practice Address - Country:US
Practice Address - Phone:978-433-6130
Practice Address - Fax:978-433-1881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEPPERELL PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACS35413336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy