Organization
THEATRE PHARMACY INC
Active
Other names
Theatre Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN CAMELIO RPH. (PHARMACIST)
(781) 862-4480
Entity
Organization
Contact information
Practice address
1784 MASSACHUSETTS AVE, LEXINGTON, MA 02420-5302
(781) 862-4480
(781) 860-9567
Mailing address
1784 MASSACHUSETTS AVE, LEXINGTON, MA 02420-5302
(781) 862-4480
(781) 860-9567
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
8761
MA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0414832
—
MA
01
—
2208761
OTHER ID NUMBER
—
Enumeration date
01/16/2007
Last updated
01/08/2019
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