Organization
LIGHTHOUSE MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY E O'DOUGHERTY (AUTHORIZED OFFICIAL - PRESIDENT)
(203) 575-1401
Entity
Organization
Contact information
Practice address
245 LONG HILL RD, MIDDLETOWN, CT 06457-4063
(866) 633-0005
(860) 343-8111
Mailing address
245 LONG HILL RD, MIDDLETOWN, CT 06457-4063
(866) 633-0005
(860) 343-8111
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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