Organization
THE FORTY-FOUR WILLOW STREET CORP.
Active
Other names
Shan Lor Drug
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD KRASKER RPH (OWNER/PRESIDENT)
(781) 324-0400
Entity
Organization
Contact information
Practice address
44 WILLOW ST, MALDEN, MA 02148-5832
(781) 324-0400
Mailing address
44 WILLOW ST, MALDEN, MA 02148-5832
(781) 324-0400
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
9573
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0427977
—
MA
Enumeration date
10/31/2006
Last updated
08/22/2020
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