Provider Demographics
NPI:1891739645
Name:ABH PHARMACY LLC
Entity Type:Organization
Organization Name:ABH PHARMACY LLC
Other - Org Name:ABH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:PUCCINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-315-2634
Mailing Address - Street 1:189 ALPS ROAD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-315-2634
Mailing Address - Fax:203-315-2154
Practice Address - Street 1:189 ALPS RD
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-4771
Practice Address - Country:US
Practice Address - Phone:203-315-2634
Practice Address - Fax:203-315-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
CTPCY.00017053336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2002410OtherPK
CT004214714Medicaid