Provider Demographics
NPI:1629396403
Name:HANCOCK PHARMACY VII LLC
Entity Type:Organization
Organization Name:HANCOCK PHARMACY VII LLC
Other - Org Name:HANCOCK PHARMACY VII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER / PHARMACIST IN CHARGE (PIC)
Authorized Official - Prefix:
Authorized Official - First Name:LALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASUPULETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-776-7100
Mailing Address - Street 1:306 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3730
Mailing Address - Country:US
Mailing Address - Phone:203-776-7100
Mailing Address - Fax:203-776-7102
Practice Address - Street 1:306 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3730
Practice Address - Country:US
Practice Address - Phone:203-776-7100
Practice Address - Fax:203-776-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.00021743336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0721995OtherNCPDP
CT008017235Medicaid
2124970OtherPK
CTPCY.0002174OtherBOARD OF PHARMACY
CTPCY.0002174OtherBOARD OF PHARMACY