Provider Demographics
NPI:1790838365
Name:NORTH STREET PHARMACY
Entity Type:Organization
Organization Name:NORTH STREET PHARMACY
Other - Org Name:FISCELLA INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FISCELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:1203-869-2130
Mailing Address - Street 1:1043 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-2701
Mailing Address - Country:US
Mailing Address - Phone:203-869-2130
Mailing Address - Fax:203-869-9227
Practice Address - Street 1:1043 NORTH STREET
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-2701
Practice Address - Country:US
Practice Address - Phone:203-869-2130
Practice Address - Fax:203-869-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0711437OtherNABP#
CTPCY0000741OtherSTATE LICENSE