Provider Demographics
NPI:1558439356
Name:RM ANDERSON, INC.
Entity Type:Organization
Organization Name:RM ANDERSON, INC.
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-327-4479
Mailing Address - Street 1:296 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1720
Mailing Address - Country:US
Mailing Address - Phone:203-327-4479
Mailing Address - Fax:
Practice Address - Street 1:296 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1720
Practice Address - Country:US
Practice Address - Phone:203-327-4479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1772333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004213740Medicaid
0711716OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CTBT7177909OtherDEA #
0711716OtherOTHER ID NUMBER-COMMERCIAL NUMBER