# CONNECTICUT PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Connecticut Pharmacy LLC, CONNECTICUT PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063757631
- **Authorized official:** SCOTT WOLAK RPH (PRESIDENT/CEO)
- **Authorized official phone:** (203) 518-1146

## Contact information

- **Practice address:** 664 MAIN AVE UNIT B101-102, NORWALK, CT 06851-1162
- **Practice address phone:** (203) 939-1790
- **Practice address fax:** (203) 939-1789
- **Mailing address:** 11 BISHOP RD, OXFORD, CT 06478-1597
- **Mailing address phone:** (203) 888-5454
- **Mailing address fax:** (203) 828-6236

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 0002254 | CT | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 12/07/2012
- **Last updated:** 10/29/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 008043469 | — | CT |
| 01 | — | 0722973 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |