Provider Demographics
NPI:1588122329
Name:WALSH PHARMACY OF ROCK STREET INC
Entity type:Organization
Organization Name:WALSH PHARMACY OF ROCK STREET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTERNAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-679-1300
Mailing Address - Street 1:202 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3212
Mailing Address - Country:US
Mailing Address - Phone:508-679-1300
Mailing Address - Fax:508-678-6796
Practice Address - Street 1:202 ROCK ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3212
Practice Address - Country:US
Practice Address - Phone:508-679-1300
Practice Address - Fax:508-678-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1035808Medicaid
MA0428671Medicaid
RIWP03910Medicaid