Provider Demographics
NPI:1518063965
Name:FORT HILL PHARMACY INC
Entity Type:Organization
Organization Name:FORT HILL PHARMACY INC
Other - Org Name:FORT HILL PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFEREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-445-6431
Mailing Address - Street 1:116 FORT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4335
Mailing Address - Country:US
Mailing Address - Phone:860-445-6431
Mailing Address - Fax:860-446-0530
Practice Address - Street 1:116 FORT HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4335
Practice Address - Country:US
Practice Address - Phone:860-445-6431
Practice Address - Fax:860-446-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CT02853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0708543OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CT004027389Medicaid
CT0305350001Medicare NSC