NPIMap

Organization Active NPI

Theatre Pharmacy Inc

Doing business as Theatre Pharmacy

  • Community/Retail Pharmacy
  • Lexington, MA
National Provider Identifier
1083765903
Registry record updated Jan 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
8761 Issued in MA
Legal business name
THEATRE PHARMACY INC
Doing business as
Theatre Pharmacy
Practice address
1784 Massachusetts Ave
Lexington, MA 02420-5302
Phone
(781) 862-4480
Fax
(781) 860-9567
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2019

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

Authorized official

Name
Stephen Camelio, RPH.NPI 1639768427
Title
Pharmacist
Phone
(781) 862-4480

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 8761 MA Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1784 Massachusetts Ave
Lexington, MA 02420-5302

Mailing address

1784 Massachusetts Ave
Lexington, MA 02420-5302
Phone (781) 862-4480

Other identifiers 2

IdentifierTypeStateIssuer
2208761OtherOTHER ID NUMBER
0414832MedicaidMA

Other names 1

  • Theatre Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

1784 Massachusetts Ave
Lexington, MA 02420
Phone (781) 862-4480

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546905600000",
    "number": "1083765903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1784 MASSACHUSETTS AVE",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024205302",
            "telephone_number": "781-862-4480",
            "fax_number": "781-860-9567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1784 MASSACHUSETTS AVE",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024205302",
            "telephone_number": "781-862-4480",
            "fax_number": "781-860-9567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEATRE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2019-01-08",
        "status": "A",
        "authorized_official_last_name": "CAMELIO",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "781-862-4480",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MA",
            "license": "8761",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2208761",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0414832",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Theatre Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lexington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; 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.