Organization
MANCHESTER PHARMACY LLC
Active
Other names
MANCHESTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAY VASIREDDY (PRESIDENT)
(914) 318-0787
Entity
Organization
Contact information
Practice address
348 MAIN ST, MANCHESTER, CT 06040-4123
(860) 649-1025
(860) 649-0457
Mailing address
348 MAIN ST, MANCHESTER, CT 06040-4123
(860) 649-1025
(860) 649-0457
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PCY.0001290
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008002078
—
CT
01
—
0722593
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/26/2011
Last updated
10/26/2011
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