Organization
COMPUTERX PHARMACY INC
Active
Other names
ComputeRx Pharmacy IV
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WILLIAM LICAMELE PHARM. D. (CHEIF EXECUTIVE OFFICER)
(203) 375-8000
Entity
Organization
Contact information
Practice address
35 ONTARIO ST, STRATFORD, CT 06615-7135
(203) 375-8000
(800) 784-5430
Mailing address
35 ONTARIO ST, STRATFORD, CT 06615-7135
(203) 375-8000
(800) 784-5430
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1524
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076567170002
—
PA
05
—
0076567170003
—
PA
05
—
02620148
—
NY
05
—
2332587
—
OH
05
—
4645110
—
MI
05
—
7419007
—
NJ
05
—
7419015
—
NJ
05
—
81195000
—
WI
05
—
852021
—
AZ
05
—
9003226900
—
KY
05
—
9126431
—
VA
05
—
XDME03019
—
CA
Enumeration date
11/16/2005
Last updated
08/22/2020
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