Provider Demographics
NPI:1871874404
Name:STEIN, JUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 COLUMBUS AVE
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1047
Mailing Address - Country:US
Mailing Address - Phone:617-445-4545
Mailing Address - Fax:
Practice Address - Street 1:1890 COLUMBUS AVE
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1047
Practice Address - Country:US
Practice Address - Phone:617-445-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH26240OtherMASS PHARMACY LISCENSE NUMBER