Provider Demographics
NPI:1861656290
Name:MCQUADES HOME INFUSION
Entity Type:Organization
Organization Name:MCQUADES HOME INFUSION
Other - Org Name:MCQUADES SPECIALTY PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-536-3349
Mailing Address - Street 1:10 CLARA DR
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1957
Mailing Address - Country:US
Mailing Address - Phone:860-536-3349
Mailing Address - Fax:860-536-3451
Practice Address - Street 1:10 CLARA DR
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1957
Practice Address - Country:US
Practice Address - Phone:860-536-3349
Practice Address - Fax:860-536-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY00021173336C0003X
3336C0004X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0721173OtherNCPDP PROVIDER IDENTIFICATION NUMBER