Provider Demographics
NPI:1417315664
Name:HUNTLEY PHARMACIES INC
Entity Type:Organization
Organization Name:HUNTLEY PHARMACIES INC
Other - Org Name:FORD PHARMACY AND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-723-1376
Mailing Address - Street 1:2 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4112
Mailing Address - Country:US
Mailing Address - Phone:203-729-2680
Mailing Address - Fax:203-720-1626
Practice Address - Street 1:2 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4112
Practice Address - Country:US
Practice Address - Phone:203-729-2680
Practice Address - Fax:203-720-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
CT0000432333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1417315664Medicaid
2158917OtherPK
CT1417315664Medicaid