# PRESCOTT PHARMACY LTC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prescott Pharmacy LTC, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023562006
- **Authorized official:** DANIEL TIMOTHY BUFFUM (PHARMACY MANAGER)
- **Authorized official phone:** (508) 683-0260

## Contact information

- **Practice address:** 100 GROVE ST STE B12, WORCESTER, MA 01605-2630
- **Practice address phone:** (508) 683-0260
- **Practice address fax:** (508) 683-0270
- **Mailing address:** 100 GROVE ST STE B12, WORCESTER, MA 01605-2630
- **Mailing address phone:** (508) 683-0260
- **Mailing address fax:** (508) 683-0270

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | DS90051 | MA | Yes |

## Other

- **Enumeration date:** 08/08/2016
- **Last updated:** 02/23/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2162515 | PK | — |