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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