The Forty-Four Willow Street Corp.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9573 Issued in MA

Legal business name

THE FORTY-FOUR WILLOW STREET CORP.

Practice address

44 Willow St
Malden, MA 02148-5832

Phone

(781) 324-0400

NPI assigned

Oct 31, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Leonard Krasker, RPH

Title

Owner/President

Phone

(781) 324-0400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shan Lor Drug Doing business as

Locations

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184700098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 WILLOW ST",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485832",
            "telephone_number": "781-324-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 WILLOW ST",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485832",
            "telephone_number": "781-324-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FORTY-FOUR WILLOW STREET CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KRASKER",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "781-324-0400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MA",
            "license": "9573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0427977",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shan Lor Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Malden, MA
• Providers in Malden, MA by specialty
• Community/Retail Pharmacy in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.