Provider Demographics
NPI:1578578175
Name:WESTOWN PHARMACY INC
Entity Type:Organization
Organization Name:WESTOWN PHARMACY INC
Other - Org Name:WESTOWN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:VENEZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-649-9946
Mailing Address - Street 1:455 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5729
Mailing Address - Country:US
Mailing Address - Phone:860-649-9946
Mailing Address - Fax:860-646-6624
Practice Address - Street 1:455 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5729
Practice Address - Country:US
Practice Address - Phone:860-649-9946
Practice Address - Fax:860-646-6624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CT8193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0704862OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0704862OtherNCPDP PROVIDER IDENTIFICATION NUMBER