Provider Demographics
NPI:1780017202
Name:QUALITY CARE DRUG/CENTERBROOK,LLC
Entity Type:Organization
Organization Name:QUALITY CARE DRUG/CENTERBROOK,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-966-4099
Mailing Address - Street 1:33 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CENTERBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06409
Mailing Address - Country:US
Mailing Address - Phone:860-767-0162
Mailing Address - Fax:
Practice Address - Street 1:33 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409
Practice Address - Country:US
Practice Address - Phone:860-767-0162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy