# DANIELSON PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bonneville Pharmacy and Home Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063624922
- **Authorized official:** ROBERT F NETHERCOTE RPH (OWNER PRESIDENT)
- **Authorized official phone:** (860) 774-9362

## Contact information

- **Practice address:** 77 WESTCOTT RD, DANIELSON, CT 06239-2929
- **Practice address phone:** (860) 774-9362
- **Practice address fax:** (860) 779-2647
- **Mailing address:** 77 WESTCOTT RD, DANIELSON, CT 06239-2929
- **Mailing address phone:** (860) 774-9362
- **Mailing address fax:** (860) 779-2647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 159 | CT | — |
| 335E00000X | Prosthetic/Orthotic Supplier | 159 | CT | Yes |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 09/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 12DME0671CT01 | BCBS | CT |