# MEDSTAT PHARMACY LLC

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

## Provider details

- **NPI number:** 1659677185
- **Authorized official:** EDWARD PELC (VP OPERATIONS)
- **Authorized official phone:** (413) 374-9210

## Contact information

- **Practice address:** 41 NORTHWEST DR, PLAINVILLE, CT 06062-1234
- **Practice address phone:** (860) 677-2934
- **Mailing address:** 41 NORTHWEST DR, PLAINVILLE, CT 06062-1234
- **Mailing address phone:** (860) 677-2934

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 0002207 | CT | Yes |

## Other

- **Enumeration date:** 02/01/2011
- **Last updated:** 02/24/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0722341 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |