Organization
CONNECTICUT PHARMACY EAST ROCK LTC
Active
Other names
EAST ROCK PHARMACY, East Rock Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT WOLAK (RPH/PRESIDENT)
(203) 518-1146
Entity
Organization
Contact information
Practice address
10 FAIRFIELD BLVD UNIT C2, WALLINGFORD, CT 06492-5903
(203) 691-5405
(203) 691-5107
Mailing address
10 FAIRFIELD BLVD, UNIT C, WALLINGFORD, CT 06492-5903
(203) 691-5405
(203) 691-5107
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PCY0002218
CT
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008033891
—
CT
01
—
2131131
PK
—
Enumeration date
07/15/2011
Last updated
06/22/2020
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