Provider Demographics
NPI:1194366955
Name:REMEDIUM PHARMACY, LLC
Entity type:Organization
Organization Name:REMEDIUM PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF RECORD
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:IEPURE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:978-251-7070
Mailing Address - Street 1:119 DRUM HILL RD STE 392
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1505
Mailing Address - Country:US
Mailing Address - Phone:978-251-7070
Mailing Address - Fax:978-251-7071
Practice Address - Street 1:2 VINAL SQ
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1312
Practice Address - Country:US
Practice Address - Phone:978-251-7070
Practice Address - Fax:978-251-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110101531AMedicaid