Provider Demographics
NPI:1245344597
Name:SOMERS PHARMACY LLC
Entity type:Organization
Organization Name:SOMERS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-749-3433
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-0356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:629 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-2102
Practice Address - Country:US
Practice Address - Phone:860-749-3433
Practice Address - Fax:860-749-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0706400OtherOTHER ID NUMBER-COMMERCIAL NUMBER