Worcester Pharmacy LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

WORCESTER PHARMACY LLC

Doing business as

Boulevard Pharmaceutical Compounding Center

Practice address

149 Shrewsbury St
Worcester, MA 01604-4637

Phone

(508) 754-1791

Fax

(508) 795-0813

NPI assigned

Feb 9, 2007

Last updated

Sep 18, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Khalid Boukhatem, PHARMD, RPHNPI 1518602960

Title

Owner

Phone

(617) 599-2793

Specialties & licenses 2

Addresses

Other names 1

• Boulevard Pharmaceutical Compounding Center Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Khalid Boukhatem, PHARMD

  • Pharmacist
  • Worcester, MA
  • NPI 1518602960
  Authorized official Same address or phone

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568764800000",
    "number": "1821139023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 SHREWSBURY ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016044637",
            "telephone_number": "508-754-1791",
            "fax_number": "508-795-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 SHREWSBURY ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016044637",
            "telephone_number": "508-754-1791",
            "fax_number": "508-795-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WORCESTER PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2019-09-18",
        "status": "A",
        "authorized_official_last_name": "BOUKHATEM",
        "authorized_official_first_name": "KHALID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-599-2793",
        "authorized_official_credential": "PHARMD, RPH"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MA",
            "license": "2943",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulevard Pharmaceutical Compounding Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Worcester Pediatrics PC
• Worcester Physical Therapy Services, Inc.
• Worcester Physicians and Nurses Services LLC
• Worcester Polytechnic Institute
• Worcester Quality Dental. PC
• Worcester Refugee and Immigrant Support and Empowerment Rise for Health (Worcester RISE for Health)

• Compounding Pharmacy in Worcester, MA
• Providers in Worcester, MA by specialty
• Compounding Pharmacy in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.