Provider Demographics
NPI:1285301929
Name:PINE HILL PHARMACY LLC
Entity type:Organization
Organization Name:PINE HILL PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDAKANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-545-0946
Mailing Address - Street 1:19 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHERBORN
Mailing Address - State:MA
Mailing Address - Zip Code:01770-1553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERBORN
Practice Address - State:MA
Practice Address - Zip Code:01770-1553
Practice Address - Country:US
Practice Address - Phone:508-545-0946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-29
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy