Provider Demographics
NPI:1487669081
Name:UTLEY & JONES PHARMACY INC
Entity Type:Organization
Organization Name:UTLEY & JONES PHARMACY INC
Other - Org Name:UTLEY AND JONES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-887-2538
Mailing Address - Street 1:112 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2776
Mailing Address - Country:US
Mailing Address - Phone:860-887-2538
Mailing Address - Fax:860-886-1367
Practice Address - Street 1:112 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2776
Practice Address - Country:US
Practice Address - Phone:860-887-2538
Practice Address - Fax:860-886-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY.00000013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025730Medicaid
1998736OtherPK