Provider Demographics
NPI:1982203147
Name:NUTMEG PHARMACY NEW LONDON LLC
Entity Type:Organization
Organization Name:NUTMEG PHARMACY NEW LONDON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-345-3607
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-0540
Mailing Address - Country:US
Mailing Address - Phone:860-345-3607
Mailing Address - Fax:860-345-3612
Practice Address - Street 1:345 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-3726
Practice Address - Country:US
Practice Address - Phone:860-395-8264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy