Provider Demographics
NPI:1598326860
Name:DEGROFF RX, LLC
Entity Type:Organization
Organization Name:DEGROFF RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:DEGROFF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-202-9213
Mailing Address - Street 1:543 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3915
Mailing Address - Country:US
Mailing Address - Phone:860-202-9213
Mailing Address - Fax:
Practice Address - Street 1:543 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3915
Practice Address - Country:US
Practice Address - Phone:860-202-9213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy