Provider Demographics
NPI:1710074901
Name:DIXWELL PHARMACY LLC
Entity Type:Organization
Organization Name:DIXWELL PHARMACY LLC
Other - Org Name:ANNEX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-281-2718
Mailing Address - Street 1:2380 DIXWELL AVE
Mailing Address - Street 2:STE A
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1847
Mailing Address - Country:US
Mailing Address - Phone:203-281-6571
Mailing Address - Fax:203-281-2859
Practice Address - Street 1:2380A DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:203-281-2718
Practice Address - Fax:203-281-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY.00019813336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149108OtherPK
CT004250859Medicaid