Basic Information
| Provider Information | |||||||||
| NPI: | 1932649753 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BERKSHIRE COMMUNITY PHARMACY OF NORTH ADAMS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BERKSHIRE MEDICAL CENTER INC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 71 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012472504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136645333 | ||||||||
| FaxNumber: | 4136645069 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012472504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136645333 | ||||||||
| FaxNumber: | 4136645069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2017 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | RODOWICZ | ||||||||
| AuthorizedOfficialFirstName: | DARLENE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4134473003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | DS90078 | MA | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.