Provider Demographics
NPI:1184803231
Name:SUBURBAN PHARMACY
Entity type:Organization
Organization Name:SUBURBAN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RATNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-882-1800
Mailing Address - Street 1:344 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2510
Mailing Address - Country:US
Mailing Address - Phone:860-882-1800
Mailing Address - Fax:
Practice Address - Street 1:100 RETREAT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-236-0755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUBURBAN PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0317480002Medicare NSC