Provider Demographics
NPI:1639230097
Name:WESTERN MASS COMPOUNDING CENTER
Entity type:Organization
Organization Name:WESTERN MASS COMPOUNDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPRECHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:413-737-2600
Mailing Address - Street 1:138 MEMORIAL AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4046
Mailing Address - Country:US
Mailing Address - Phone:413-737-2600
Mailing Address - Fax:413-737-2555
Practice Address - Street 1:138 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4046
Practice Address - Country:US
Practice Address - Phone:413-737-2600
Practice Address - Fax:413-737-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty