Provider Demographics
NPI:1629195789
Name:STOLL'S PHARMACY, INC
Entity Type:Organization
Organization Name:STOLL'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:203-575-0199
Mailing Address - Street 1:185 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-2289
Mailing Address - Country:US
Mailing Address - Phone:203-575-0199
Mailing Address - Fax:203-575-0515
Practice Address - Street 1:185 GROVE ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2289
Practice Address - Country:US
Practice Address - Phone:203-575-0199
Practice Address - Fax:203-575-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 335E00000X
CTPCY.00013303336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004083234Medicaid
CT004083234Medicaid