Provider Demographics
NPI:1558908988
Name:PETRICONE'S APOTHECARY
Entity Type:Organization
Organization Name:PETRICONE'S APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETRICONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-469-5400
Mailing Address - Street 1:110 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790
Mailing Address - Country:US
Mailing Address - Phone:860-307-4459
Mailing Address - Fax:
Practice Address - Street 1:4 BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057
Practice Address - Country:US
Practice Address - Phone:860-469-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy