# THEATRE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Theatre Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083765903
- **Authorized official:** STEPHEN CAMELIO RPH. (PHARMACIST)
- **Authorized official phone:** (781) 862-4480

## Contact information

- **Practice address:** 1784 MASSACHUSETTS AVE, LEXINGTON, MA 02420-5302
- **Practice address phone:** (781) 862-4480
- **Practice address fax:** (781) 860-9567
- **Mailing address:** 1784 MASSACHUSETTS AVE, LEXINGTON, MA 02420-5302
- **Mailing address phone:** (781) 862-4480
- **Mailing address fax:** (781) 860-9567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 8761 | MA | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 01/16/2007
- **Last updated:** 01/08/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0414832 | — | MA |
| 01 | — | 2208761 | OTHER ID NUMBER | — |