Provider Demographics
NPI:1790141034
Name:BRASS MILL PHARMACY, LLC
Entity Type:Organization
Organization Name:BRASS MILL PHARMACY, LLC
Other - Org Name:PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JALPA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:203-721-8022
Mailing Address - Street 1:1527 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1025
Mailing Address - Country:US
Mailing Address - Phone:203-721-8022
Mailing Address - Fax:203-721-6005
Practice Address - Street 1:1527 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1025
Practice Address - Country:US
Practice Address - Phone:203-721-8022
Practice Address - Fax:203-721-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.00023293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy