Provider Demographics
NPI:1851633986
Name:CHAPEL STREET PHARMACY, LLC
Entity Type:Organization
Organization Name:CHAPEL STREET PHARMACY, LLC
Other - Org Name:CHAPEL STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:MURALIKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALLAGUNDLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-777-2227
Mailing Address - Street 1:1245 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4611
Mailing Address - Country:US
Mailing Address - Phone:203-777-2227
Mailing Address - Fax:203-777-2228
Practice Address - Street 1:1245 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4611
Practice Address - Country:US
Practice Address - Phone:203-777-2227
Practice Address - Fax:203-777-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY2262332B00000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0723103OtherNCPDP
CT008044234Medicaid
CTPCY.0002262OtherBOARD OF PHARMACY
CTPCY.0002262OtherBOARD OF PHARMACY