# PEARL STREET PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639351364
- **Authorized official:** ROCKY TENGALIA RPH (PRESIDENT)
- **Authorized official phone:** (781) 925-2378

## Contact information

- **Practice address:** 1 PEARL ST, BROCKTON, MA 02301-2864
- **Practice address phone:** (508) 588-7455
- **Practice address fax:** (508) 588-7400
- **Mailing address:** 1 PEARL ST, BROCKTON, MA 02301-2864

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | DS3565 | MA | Yes |

## Other

- **Enumeration date:** 12/05/2007
- **Last updated:** 01/03/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2242155 | OTHER ID NUMBER | — |