Provider Demographics
NPI:1598828873
Name:HEALTH COMPLEX MEDICAL INC.
Entity Type:Organization
Organization Name:HEALTH COMPLEX MEDICAL INC.
Other - Org Name:HEALTH COMPLEX PHARMACY II
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AUST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-753-7778
Mailing Address - Street 1:84 PROGRESS LN
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3829
Mailing Address - Country:US
Mailing Address - Phone:203-753-7778
Mailing Address - Fax:203-346-7593
Practice Address - Street 1:84 PROGRESS LN
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3829
Practice Address - Country:US
Practice Address - Phone:203-753-7778
Practice Address - Fax:203-346-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1846OtherCT PHARMACY LICENSE
0719863OtherNCPDP
BH8779007OtherDEA NUMBER
0719863OtherNCPDP