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Organization
MAIN STREET PHARMACY 3 LLC
Active
Organization
MAIN STREET PHARMACY 3 LLC
Active
Other names
Main Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN JACOB (MEMBER)
(203) 212-3800
Entity
Organization
Contact information
Practice address
2117 BOSTON AVE, BRIDGEPORT, CT 06610-3030
(203) 212-3800
(203) 212-3802
Mailing address
2117 BOSTON AVE, BRIDGEPORT, CT 06610-3030
(203) 212-3800
(203) 212-3802
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
PCY2190
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008032995
—
CT
01
—
2170877
PK
—
Enumeration date
01/25/2018
Last updated
01/25/2018
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