Provider Demographics
NPI:1609346576
Name:SSV PHARMACY 1
Entity Type:Organization
Organization Name:SSV PHARMACY 1
Other - Org Name:ARROW PRESCRIPTION CENTER #12 INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-522-9289
Mailing Address - Street 1:500 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3106
Mailing Address - Country:US
Mailing Address - Phone:860-570-0543
Mailing Address - Fax:860-570-0529
Practice Address - Street 1:500 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3106
Practice Address - Country:US
Practice Address - Phone:860-982-7303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy