Provider Demographics
NPI:1396562278
Name:STRATFORD APOTHECARY, LLC
Entity type:Organization
Organization Name:STRATFORD APOTHECARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:203-378-9394
Mailing Address - Street 1:1030 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4985
Mailing Address - Country:US
Mailing Address - Phone:203-378-9394
Mailing Address - Fax:203-375-8651
Practice Address - Street 1:1030 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4985
Practice Address - Country:US
Practice Address - Phone:203-378-9394
Practice Address - Fax:203-375-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier