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Organization
DANIELSON PHARMACY INC
Active
Organization
DANIELSON PHARMACY INC
Active
Other names
BONNEVILLE LTC
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT NETHERCOTE RPH (PRESIDENT)
(508) 450-3161
Entity
Organization
Contact information
Practice address
77 A WESTCOTT RD, DANIELSON, CT 06239
(860) 774-6418
(860) 779-2647
Mailing address
77 A WESTCOTT RD, DANIELSON, CT 06239
(860) 774-6418
(860) 779-2647
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
2085
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0720739
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/25/2007
Last updated
06/09/2010
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