Provider Demographics
NPI:1992211627
Name:SPECIALTY RX CONSULTING LLC
Entity Type:Organization
Organization Name:SPECIALTY RX CONSULTING LLC
Other - Org Name:CENTERBROOK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-767-1389
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 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409-1071
Practice Address - Country:US
Practice Address - Phone:860-767-7389
Practice Address - Fax:860-767-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
CTPCY.00023673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175024OtherPK