Provider Demographics
NPI:1861506164
Name:B AND L PHARMACY INC
Entity Type:Organization
Organization Name:B AND L PHARMACY INC
Other - Org Name:DELLA PIETRA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER PHARMACIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVOLSI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-754-0181
Mailing Address - Street 1:792 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-4117
Mailing Address - Country:US
Mailing Address - Phone:203-754-0181
Mailing Address - Fax:203-596-8144
Practice Address - Street 1:792 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-4117
Practice Address - Country:US
Practice Address - Phone:203-754-0181
Practice Address - Fax:203-596-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6963336C0003X
CT06963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004029856Medicaid
CT004017471Medicaid
1998890OtherPK
CT004029856Medicaid