Basic Information
| Provider Information | |||||||||
| NPI: | 1174621189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SJ PHYSICIAN SERVICES, INC DBA NASHUA MEDICAL GROUP PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000 LBX 7655 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077778202 | ||||||||
| FaxNumber: | 2077836660 | ||||||||
| Practice Location | |||||||||
| Address1: | 173 DANIEL WEBSTER HWY | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030605224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038914439 | ||||||||
| FaxNumber: | 6038914410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | PLAMONDON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6035983352 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SJ PHYSICIAN SERVICES, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | 06871 | NH | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.