Provider Demographics
NPI:1871838748
Name:HANCOCK PHARMACY III, LLC
Entity Type:Organization
Organization Name:HANCOCK PHARMACY III, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:APPALANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-568-9000
Mailing Address - Street 1:3768 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3768 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3610
Practice Address - Country:US
Practice Address - Phone:917-568-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2020-11-20
Deactivation Date:2020-11-06
Deactivation Code:
Reactivation Date:2020-11-20
Provider Licenses
StateLicense IDTaxonomies
CT332B00000X
CTPCY.00022563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies