# NUTMEG PHARMACY MOODUS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Nutmeg Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124636469
- **Authorized official:** BETH-ANN LAROSA (OFFICE MANAGER)
- **Authorized official phone:** (860) 345-3607

## Contact information

- **Practice address:** 26 FALLS RD, MOODUS, CT 06469-1262
- **Practice address phone:** (860) 891-8142
- **Mailing address:** PO BOX 540, HIGGANUM, CT 06441-0540
- **Mailing address phone:** (860) 345-3607

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 07/22/2020
- **Last updated:** 01/31/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 008092217 | — | CT |