Provider Demographics
NPI:1700983525
Name:KONTOS INC. ALEXANDER S. PHARMACY
Entity type:Organization
Organization Name:KONTOS INC. ALEXANDER S. PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KONTOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:978-957-0330
Mailing Address - Street 1:505 NASHUA RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1929
Mailing Address - Country:US
Mailing Address - Phone:978-957-0330
Mailing Address - Fax:978-957-1817
Practice Address - Street 1:505 NASHUA RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-1929
Practice Address - Country:US
Practice Address - Phone:978-957-0330
Practice Address - Fax:978-957-1817
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KONTOS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA63493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0432458Medicaid
MA0432458Medicaid