Provider Demographics
NPI:1235201997
Name:BORDONARO'S PHARMACY INC.
Entity Type:Organization
Organization Name:BORDONARO'S PHARMACY INC.
Other - Org Name:THE MEDICINE CENTRE BORDONARO'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BORDONARO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-342-3390
Mailing Address - Street 1:283 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1856
Mailing Address - Country:US
Mailing Address - Phone:860-342-3390
Mailing Address - Fax:860-342-3391
Practice Address - Street 1:283 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1856
Practice Address - Country:US
Practice Address - Phone:860-342-3390
Practice Address - Fax:860-342-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT752332B00000X, 3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004032512Medicaid
CT0701549OtherNABP
CT12DME0003CT01OtherBLUE CROSS DME
CT004018933OtherMEDICAID DME
CT0701549OtherNABP