Organization
BLACK ROCK PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH H LEE RPH (OWNER)
(917) 532-1285
Entity
Organization
Contact information
Practice address
1838 BLACK ROCK TPKE, FAIRFIELD, CT 06825-3500
(917) 532-1285
Mailing address
1838 BLACK ROCK TPKE, FAIRFIELD, CT 06825-3500
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2386
PHARMACY LICENSE
CT
Enumeration date
01/17/2019
Last updated
01/17/2019
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