Provider Demographics
NPI:1760051486
Name:FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Entity Type:Organization
Organization Name:FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Other - Org Name:GRAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS DEVELOPMENT ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:VEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPADIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-777-7411
Mailing Address - Street 1:374 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3733
Mailing Address - Country:US
Mailing Address - Phone:203-974-5365
Mailing Address - Fax:877-580-1279
Practice Address - Street 1:221 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4022
Practice Address - Country:US
Practice Address - Phone:203-974-5365
Practice Address - Fax:877-580-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy