Provider Demographics
NPI:1154645356
Name:HANCOCK PHARMACY II LLC
Entity Type:Organization
Organization Name:HANCOCK PHARMACY II LLC
Other - Org Name:HANCOCK PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER AKA SP
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:LAKSHMI
Authorized Official - Last Name:DEVADI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-576-9000
Mailing Address - Street 1:1020 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1187
Mailing Address - Country:US
Mailing Address - Phone:203-576-9000
Mailing Address - Fax:203-576-9005
Practice Address - Street 1:1020 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1187
Practice Address - Country:US
Practice Address - Phone:203-576-9000
Practice Address - Fax:203-576-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2023-03-07
Deactivation Date:2020-11-06
Deactivation Code:
Reactivation Date:2020-11-20
Provider Licenses
StateLicense IDTaxonomies
CTPCY.0002165332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT721882OtherNCPDP
CT1154645356OtherNPI
CTPCY.0002165OtherBOARD OF PHARMACY
CTPCY.0002165OtherBOARD OF PHARMACY
CTPCY.0002165OtherBOARD OF PHARMACY