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Organization
CONNECTICUT PHARMACY EAST ROCK LTC
Active
Organization
CONNECTICUT PHARMACY EAST ROCK LTC
Active
Other names
EAST ROCK PHARMACY, East Rock Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT WOLAK (RPH/PRESIDENT)
(203) 518-1146
Entity
Organization
Contact information
Practice address
10 FAIRFIELD BLVD UNIT C2, WALLINGFORD, CT 06492-5903
(203) 691-5405
(203) 691-5107
Mailing address
10 FAIRFIELD BLVD, UNIT C, WALLINGFORD, CT 06492-5903
(203) 691-5405
(203) 691-5107
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
PCY0002218
CT
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008033891
—
CT
01
—
2131131
PK
—
Enumeration date
07/15/2011
Last updated
06/22/2020
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