Provider Demographics
NPI:1205237476
Name:BRASS CITY PHARMACY INC
Entity type:Organization
Organization Name:BRASS CITY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SREENIVASA
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLAPAREDDYGARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-624-5088
Mailing Address - Street 1:558 CHASE AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1947
Mailing Address - Country:US
Mailing Address - Phone:203-759-5000
Mailing Address - Fax:
Practice Address - Street 1:558 CHASE AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1947
Practice Address - Country:US
Practice Address - Phone:203-759-5000
Practice Address - Fax:203-759-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7364300001Medicare NSC