Provider Demographics
NPI:1538602511
Name:ONCO PHARMACEUTICAL SERVICES OF MA, LLC
Entity type:Organization
Organization Name:ONCO PHARMACEUTICAL SERVICES OF MA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:JARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-416-1483
Mailing Address - Street 1:13410 EASTPOINT CENTRE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4160
Mailing Address - Country:US
Mailing Address - Phone:877-663-6633
Mailing Address - Fax:502-849-0643
Practice Address - Street 1:150 BEAR HILL RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1028
Practice Address - Country:US
Practice Address - Phone:781-290-0030
Practice Address - Fax:781-290-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS897023336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084520Medicaid
MADS89702OtherPHARMACY PERMIT
MA110084520Medicaid