Provider Demographics
NPI:1689964272
Name:HANCOCK PHARMACY AT LONG WHARF INC
Entity Type:Organization
Organization Name:HANCOCK PHARMACY AT LONG WHARF INC
Other - Org Name:HANCOCK PHARMACY AT LONG WHARF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-235-6323
Mailing Address - Street 1:1 LONG WHARF DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5991
Mailing Address - Country:US
Mailing Address - Phone:203-235-6323
Mailing Address - Fax:
Practice Address - Street 1:1 LONG WHARF DR STE 116
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5991
Practice Address - Country:US
Practice Address - Phone:203-235-6323
Practice Address - Fax:203-776-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.00022113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129987OtherPK