Provider Demographics
NPI:1245362433
Name:MCCARTHY, MAUREEN ANNE (RPH)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANNE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-0484
Mailing Address - Country:US
Mailing Address - Phone:508-421-1900
Mailing Address - Fax:508-334-2264
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:PRESCRIPTION CENTER PHARMACY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-421-1900
Practice Address - Fax:508-334-2264
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17634OtherPHARMACIST LICENSE