Provider Demographics
NPI:1225482490
Name:MEDICAL CENTER PHARMACY INC
Entity Type:Organization
Organization Name:MEDICAL CENTER PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, OUTPATIENT PHARMACY SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:TERRI SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:844-881-0043
Mailing Address - Street 1:1100 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1363
Mailing Address - Country:US
Mailing Address - Phone:844-881-0043
Mailing Address - Fax:203-230-0679
Practice Address - Street 1:1100 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:844-881-0043
Practice Address - Fax:203-230-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035111332B00000X
FLPH30970333600000X
CTPCY.00023303336C0003X
RIPHN113483336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157992OtherPK
CT0235270003Medicare NSC