Organization
CITY DRUG INC
Active
Other names
State Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
OLEG URIM BS PHARM (PRESIDENT)
(781) 405-3228
Entity
Organization
Contact information
Practice address
22 STATE ST, LYNN, MA 01901-1505
(781) 599-0900
Mailing address
22 STATE ST, LYNN, MA 01901-1505
(781) 599-0900
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
DS89810
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135003
PK
—
Enumeration date
05/02/2012
Last updated
12/28/2015
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