Provider Demographics
NPI:1629077912
Name:ARROW PRESCRIPTION CENTER 14 INC
Entity Type:Organization
Organization Name:ARROW PRESCRIPTION CENTER 14 INC
Other - Org Name:ARROW PRESCRIPTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-527-2800
Mailing Address - Street 1:100 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1223
Mailing Address - Country:US
Mailing Address - Phone:860-527-2800
Mailing Address - Fax:860-527-1381
Practice Address - Street 1:100 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1223
Practice Address - Country:US
Practice Address - Phone:860-527-2800
Practice Address - Fax:860-527-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.00011173336C0003X
3336L0003X
CT011173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1999585OtherPK
CT004093118Medicaid
1999585OtherPK