Provider Demographics
NPI:1578012324
Name:COMMUNITY HEALTH PHARMACY LLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH PHARMACY LLC
Other - Org Name:COMMUNITY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHEEMIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-645-1450
Mailing Address - Street 1:210 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3416
Mailing Address - Country:US
Mailing Address - Phone:203-498-1900
Mailing Address - Fax:203-498-1909
Practice Address - Street 1:210 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3416
Practice Address - Country:US
Practice Address - Phone:203-498-1900
Practice Address - Fax:203-498-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY.00023413336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164382OtherPK