Provider Demographics
NPI:1922495563
Name:COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY INC
Other - Org Name:RIVERSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DHULIPALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-270-8013
Mailing Address - Street 1:926 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2237
Mailing Address - Country:US
Mailing Address - Phone:201-270-8013
Mailing Address - Fax:
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2237
Practice Address - Country:US
Practice Address - Phone:201-270-8013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY00023113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy