Provider Demographics
NPI:1669927703
Name:HARTFORD HEALTHCARE RETAIL PHARMACY
Entity type:Organization
Organization Name:HARTFORD HEALTHCARE RETAIL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-727-1123
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-727-1123
Mailing Address - Fax:860-520-4307
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 117
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-727-1123
Practice Address - Fax:860-520-4307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARTFORD HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy