Organization
CONNECTICUT PHARMACY LLC
Active
Other names
Connecticut Pharmacy LLC, CONNECTICUT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT WOLAK RPH (PRESIDENT/CEO)
(203) 518-1146
Entity
Organization
Contact information
Practice address
664 MAIN AVE UNIT B101-102, NORWALK, CT 06851-1162
(203) 939-1790
(203) 939-1789
Mailing address
11 BISHOP RD, OXFORD, CT 06478-1597
(203) 888-5454
(203) 828-6236
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
0002254
CT
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008043469
—
CT
01
—
0722973
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/07/2012
Last updated
10/29/2018
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