# SUBURBAN PHARMACY LTC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SUBURBAN PHARMACY LTC INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932236775
- **Authorized official:** MR. RATNA KUMAR KAMMULURI RPH (PHARMACIST)
- **Authorized official phone:** (860) 882-1808

## Contact information

- **Practice address:** 342 N MAIN ST, STE 70, WEST HARTFORD, CT 06117-2500
- **Practice address phone:** (860) 882-1808
- **Practice address fax:** (860) 882-1791
- **Mailing address:** 342 N MAIN ST, STE 70, WEST HARTFORD, CT 06117-2500
- **Mailing address phone:** (860) 882-1808
- **Mailing address fax:** (860) 882-1791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 2051 | CT | Yes |

## Other

- **Enumeration date:** 02/28/2007
- **Last updated:** 09/19/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0720690 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |