Provider Demographics
NPI:1356668362
Name:HANCOCK PHARMACY VI LLC
Entity Type:Organization
Organization Name:HANCOCK PHARMACY VI LLC
Other - Org Name:HANCOCK PHARMACY VI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAIKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALASANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-734-8900
Mailing Address - Street 1:95 WAKELEE AVE
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1151
Mailing Address - Country:US
Mailing Address - Phone:203-734-8900
Mailing Address - Fax:203-734-8903
Practice Address - Street 1:95 WAKELEE AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1151
Practice Address - Country:US
Practice Address - Phone:203-734-8900
Practice Address - Fax:203-734-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.00021763336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124969OtherPK
CT008021293Medicaid
0721945OtherNCPDP PROVIDER IDENTIFICATION NUMBER