Provider Demographics
NPI:1023184785
Name:MILE HILL PHARMACY LLC
Entity Type:Organization
Organization Name:MILE HILL PHARMACY LLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VETICA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-875-2507
Mailing Address - Street 1:79 EAST ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79 EAST ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3845
Practice Address - Country:US
Practice Address - Phone:860-875-2507
Practice Address - Fax:860-870-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000793332B00000X
CT0793333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0706272OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CT004030383Medicaid
0706272OtherOTHER ID NUMBER-COMMERCIAL NUMBER