Provider Demographics
NPI:1093139172
Name:SSACT RX INC
Entity Type:Organization
Organization Name:SSACT RX INC
Other - Org Name:ARCH STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SREENIVASA
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLAPAREDDYGARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-624-5088
Mailing Address - Street 1:333 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2520
Mailing Address - Country:US
Mailing Address - Phone:860-225-9000
Mailing Address - Fax:860-225-9100
Practice Address - Street 1:333 ARCH ST
Practice Address - Street 2:ARCH STREET PHARMACY
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2520
Practice Address - Country:US
Practice Address - Phone:860-225-9000
Practice Address - Fax:860-225-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY00022883336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008050967Medicaid
CT008057228Medicaid
2144255OtherPK
CT008057228Medicaid