Organization
SUBURBAN PHARMACY LTC INC
Active
Other names
SUBURBAN PHARMACY LTC INC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RATNA KUMAR KAMMULURI RPH (PHARMACIST)
(860) 882-1808
Entity
Organization
Contact information
Practice address
342 N MAIN ST, STE 70, WEST HARTFORD, CT 06117-2500
(860) 882-1808
(860) 882-1791
Mailing address
342 N MAIN ST, STE 70, WEST HARTFORD, CT 06117-2500
(860) 882-1808
(860) 882-1791
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
2051
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0720690
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/28/2007
Last updated
09/19/2024
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