Provider Demographics
NPI:1275926990
Name:NAUGATUCK PHARMACY
Entity Type:Organization
Organization Name:NAUGATUCK PHARMACY
Other - Org Name:NAUGATUCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-583-6889
Mailing Address - Street 1:153 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4256
Mailing Address - Country:US
Mailing Address - Phone:203-632-8380
Mailing Address - Fax:203-632-8429
Practice Address - Street 1:153 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4256
Practice Address - Country:US
Practice Address - Phone:203-632-8380
Practice Address - Fax:203-632-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CT23103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008062816Medicaid
CT008059580Medicaid
2150644OtherPK
7430360001Medicare NSC