Provider Demographics
NPI:1396410692
Name:STOLL'S PHARMACY, INC
Entity Type:Organization
Organization Name:STOLL'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-575-0199
Mailing Address - Street 1:185 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-2289
Mailing Address - Country:US
Mailing Address - Phone:203-575-0199
Mailing Address - Fax:203-575-0515
Practice Address - Street 1:185 GROVE ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2289
Practice Address - Country:US
Practice Address - Phone:203-575-0199
Practice Address - Fax:203-575-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004082955Medicaid