Organization
SUBURBAN PHARMA INC
Active
Other names
SUBURBAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SATISH ANNAMANENI (PHARMACY DIRECTOR/AO)
(860) 236-3564
Entity
Organization
Contact information
Practice address
344 N MAIN ST, WEST HARTFORD, CT 06117-2526
(860) 236-3564
(860) 236-7053
Mailing address
344 N MAIN ST, WEST HARTFORD, CT 06117-2526
(860) 236-3564
(860) 236-7053
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2051
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004027215
—
CT
01
—
2125413
PK
—
Enumeration date
09/15/2006
Last updated
07/19/2018
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