NPIMap

Organization Active NPI

Maverick Specialty Retail Pharmacy

  • Specialty Pharmacy
  • East Boston, MA
National Provider Identifier
1013621598
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
Legal business name
MAVERICK SPECIALTY RETAIL PHARMACY
Practice address
20 Maverick SQ
East Boston, MA 02128-2335
Phone
(617) 568-4781
NPI assigned
Jan 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gregory Wilmot
Title
President & Ceo
Phone
(617) 568-4570

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Specialty Pharmacy 3336S0011X Primary

Addresses

Primary practice location

20 Maverick SQ
East Boston, MA 02128-2335

Mailing address

20 Maverick SQ
East Boston, MA 02128-2335
Phone (978) 879-9988

National Provider Directory

National Provider Directory
Tax ID family
East Neighborhood Heal7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

20 Maverick Sq
East Boston, MA 02128
Phone (617) 569-5800

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1013621598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 MAVERICK SQ",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021282335",
            "telephone_number": "978-879-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 MAVERICK SQ",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "021282335",
            "telephone_number": "617-568-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVERICK SPECIALTY RETAIL PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "WILMOT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "617-568-4570"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.