Provider Demographics
NPI:1407913486
Name:IVERY AND DUDLEY INC
Entity Type:Organization
Organization Name:IVERY AND DUDLEY INC
Other - Org Name:IVERY AND DUDLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARISI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-738-1055
Mailing Address - Street 1:118 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1713
Mailing Address - Country:US
Mailing Address - Phone:860-738-1055
Mailing Address - Fax:800-856-0221
Practice Address - Street 1:118 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1713
Practice Address - Country:US
Practice Address - Phone:860-738-1055
Practice Address - Fax:800-856-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4632332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0274650001Medicare ID - Type Unspecified