Provider Demographics
NPI:1588812176
Name:KENT APOTHECARY LLC
Entity Type:Organization
Organization Name:KENT APOTHECARY LLC
Other - Org Name:KENT STATION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAPRILE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:860-927-3725
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-0632
Mailing Address - Country:US
Mailing Address - Phone:860-927-3725
Mailing Address - Fax:860-927-3895
Practice Address - Street 1:38 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1511
Practice Address - Country:US
Practice Address - Phone:860-927-3725
Practice Address - Fax:860-927-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CTPCY.00002793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116845OtherPK
CT1588812176Medicaid