Ryan Bourassa – Pharmacist in Pittsfield, MA

Key facts

NPI: 1003540246
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: PH26202 (MA)
Practice address: 200 West St
Pittsfield, MA 01201-5862
Phone: (413) 447-9844
Fax: (413) 447-9041
NPI assigned: Jul 13, 2022
Sex: Male
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Big Y Foods Inc Community/Retail Pharmacy · Pittsfield, MA · NPI 1487743019

NPD (past)
Big Y Foods, Inc Community/Retail Pharmacy · Mystic, CT · NPI 1700194867

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
PH26202	MA	MD	Pharmacist

Practice roles

Organization	Specialty	Status	New patients
Big Y Foods, Inc		Past since Jul 17, 2022	Accepting new patients
Big Y Foods Inc		Past since Jul 17, 2022	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	PH26202	MA	Yes

Addresses

Primary practice location

200 West St
Pittsfield, MA 01201-5862

Mailing address

101 Patricia Ave
Dalton, MA 01226-2046
Phone (413) 841-1006

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 13, 2022.

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1003540246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PATRICIA AVE",
            "city": "DALTON",
            "state": "MA",
            "postal_code": "012262046",
            "telephone_number": "413-841-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WEST ST",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012015862",
            "telephone_number": "413-447-9844",
            "fax_number": "413-447-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURASSA",
        "first_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "PH26202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsfield, MA

All providers in Pittsfield, MA · Pharmacist in Massachusetts

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.