Provider Demographics
NPI:1669486940
Name:W.H. PICKETT DRUG CO
Entity Type:Organization
Organization Name:W.H. PICKETT DRUG CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STUKSHIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-753-5158
Mailing Address - Street 1:675 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-3508
Mailing Address - Country:US
Mailing Address - Phone:203-753-5158
Mailing Address - Fax:203-597-0625
Practice Address - Street 1:675 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-3508
Practice Address - Country:US
Practice Address - Phone:203-753-5158
Practice Address - Fax:203-597-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
CT4213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004028148Medicaid
CT004028148Medicaid