Organization
CONNECTICUT PHARMACY OF MADISON LLC
Active
Other names
CONNECTICUT PHARMACY OF MADISON
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT WOLAK (PRESIDENT)
(203) 518-1146
Entity
Organization
Contact information
Practice address
200 BOSTON POST RD STE 9, MADISON, CT 06443-2144
(203) 421-2132
(203) 421-2135
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY0002300
CT
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147371
PK
—
Enumeration date
09/05/2014
Last updated
11/29/2016
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