Provider Demographics
NPI:1336127984
Name:BRIDGEPORT CHEMISTS, INC.
Entity Type:Organization
Organization Name:BRIDGEPORT CHEMISTS, INC.
Other - Org Name:HANCOCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:APPALANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-568-9000
Mailing Address - Street 1:1407 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1928
Mailing Address - Country:US
Mailing Address - Phone:203-367-4571
Mailing Address - Fax:
Practice Address - Street 1:1407 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1928
Practice Address - Country:US
Practice Address - Phone:203-367-4571
Practice Address - Fax:203-368-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004216794Medicaid