Provider Demographics
NPI:1417990680
Name:THE ROBERT C GEER MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:THE ROBERT C GEER MEMORIAL HOSPITAL INC
Other - Org Name:GEER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM D, DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:826-824-3822
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-0819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 S CANAAN RD
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2502
Practice Address - Country:US
Practice Address - Phone:860-824-3822
Practice Address - Fax:860-824-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CTPCY00018243336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2002503OtherPK
CT4226941Medicaid