Provider Demographics
NPI:1023180973
Name:NELSON'S PHARMACY, INC.
Entity Type:Organization
Organization Name:NELSON'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GIRIACO
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-729-2297
Mailing Address - Street 1:153 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4256
Mailing Address - Country:US
Mailing Address - Phone:203-729-2297
Mailing Address - Fax:203-729-1134
Practice Address - Street 1:153 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4256
Practice Address - Country:US
Practice Address - Phone:203-729-2297
Practice Address - Fax:203-729-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004073995Medicaid
CT040690001OtherDMERC SUPPLIER ID
CT0404690001Medicare NSC