Provider Demographics
NPI:1336714393
Name:WEST HARTFORD APOTHECARY LLC
Entity Type:Organization
Organization Name:WEST HARTFORD APOTHECARY LLC
Other - Org Name:WEST HARTFORD APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-343-5220
Mailing Address - Street 1:994 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2147
Mailing Address - Country:US
Mailing Address - Phone:860-904-6063
Mailing Address - Fax:860-519-0036
Practice Address - Street 1:994 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2147
Practice Address - Country:US
Practice Address - Phone:860-904-6063
Practice Address - Fax:860-519-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-22
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy