Provider Demographics
NPI:1043684582
Name:GALAXY PHARMACY BOSTON INC
Entity type:Organization
Organization Name:GALAXY PHARMACY BOSTON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-331-5065
Mailing Address - Street 1:534 DORCHESTER AVE UNIT C-1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2762
Mailing Address - Country:US
Mailing Address - Phone:617-268-0800
Mailing Address - Fax:
Practice Address - Street 1:534 DORCHESTER AVE UNIT C-1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127
Practice Address - Country:US
Practice Address - Phone:617-268-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS902553336C0003X, 3336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110108452AMedicaid
2155756OtherPK