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Organization
WORCESTER PHARMACY LLC
Active
Organization
WORCESTER PHARMACY LLC
Active
Other names
Boulevard Pharmaceutical Compounding Center
Organization subpart
No
Provider details
NPI number
Authorized official
KHALID BOUKHATEM PHARMD, RPH (OWNER)
(617) 599-2793
Entity
Organization
Contact information
Practice address
149 SHREWSBURY ST, WORCESTER, MA 01604-4637
(508) 754-1791
(508) 795-0813
Mailing address
149 SHREWSBURY ST, WORCESTER, MA 01604-4637
(508) 754-1791
(508) 795-0813
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
2943
MA
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
02/09/2007
Last updated
09/18/2019
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