Provider Demographics
NPI:1699056820
Name:TOMS NEW PLACE LLC
Entity type:Organization
Organization Name:TOMS NEW PLACE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:508-264-9303
Mailing Address - Street 1:387 QUARRY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1025
Mailing Address - Country:US
Mailing Address - Phone:774-322-1335
Mailing Address - Fax:508-617-4546
Practice Address - Street 1:387 QUARRY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1025
Practice Address - Country:US
Practice Address - Phone:774-322-1335
Practice Address - Fax:508-617-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MADS898143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110092534AMedicaid
2131802OtherPK