Organization
DANIELSON PHARMACY INC
Active
Other names
Bonneville Pharmacy and Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT F NETHERCOTE RPH (OWNER PRESIDENT)
(860) 774-9362
Entity
Organization
Contact information
Practice address
77 WESTCOTT RD, DANIELSON, CT 06239-2929
(860) 774-9362
(860) 779-2647
Mailing address
77 WESTCOTT RD, DANIELSON, CT 06239-2929
(860) 774-9362
(860) 779-2647
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
159
CT
335E00000X
Prosthetic/Orthotic Supplier
Primary
159
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12DME0671CT01
BCBS
CT
Enumeration date
05/04/2007
Last updated
09/11/2025
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