Provider Demographics
NPI:1154387553
Name:AIRLINE DRUG INC
Entity type:Organization
Organization Name:AIRLINE DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:413-596-2431
Mailing Address - Street 1:2689 BOSTON RD
Mailing Address - Street 2:PO BOX 966
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1141
Mailing Address - Country:US
Mailing Address - Phone:413-596-2431
Mailing Address - Fax:413-596-2966
Practice Address - Street 1:1481 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-3900
Practice Address - Country:US
Practice Address - Phone:413-534-5677
Practice Address - Fax:413-536-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0419826Medicaid
MA0419826Medicaid