Provider Demographics
NPI:1811199979
Name:BURGDORF PHARMACY INC
Entity Type:Organization
Organization Name:BURGDORF PHARMACY INC
Other - Org Name:ARROW PRESCRIPTON CENTER #13
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-570-0543
Mailing Address - Street 1:500 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06115
Mailing Address - Country:US
Mailing Address - Phone:860-570-0543
Mailing Address - Fax:860-570-0529
Practice Address - Street 1:131 COVENTRY STREET
Practice Address - Street 2:2ND FL
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-286-2766
Practice Address - Fax:860-286-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01571332B00000X, 332BC3200X, 332BP3500X, 332BX2000X, 333600000X, 3336C0002X, 3336C0003X, 3336C0004X, 3336H0001X, 3336I0012X, 3336L0003X, 3336M0002X, 3336M0003X, 3336S0011X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0002XSuppliersPharmacyClinic Pharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Not Answered3336I0012XSuppliersPharmacyInstitutional Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Not Answered3336M0002XSuppliersPharmacyMail Order Pharmacy
Not Answered3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1078410001Medicare ID - Type Unspecified