Organization
MEDICINE CENTRE LTC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM CARLONE RPH (OWNER)
(860) 983-8066
Entity
Organization
Contact information
Practice address
41 SULLIVAN ST, SPRINGFIELD, MA 01104
(413) 739-6100
(413) 739-6106
Mailing address
41 SULLIVAN ST, SPRINGFIELD, MA 01104
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
3455
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2241468
OTHER ID NUMBER
—
Enumeration date
08/10/2006
Last updated
09/15/2008
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