Provider Demographics
NPI:1740367564
Name:NEW LONDON PHARMACY INC
Entity type:Organization
Organization Name:NEW LONDON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-243-4987
Mailing Address - Street 1:246 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-243-4987
Mailing Address - Fax:212-243-7110
Practice Address - Street 1:246 8TH AVE
Practice Address - Street 2:
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-243-4987
Practice Address - Fax:212-243-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY85303336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008530OtherLIC NUMBER
NY00259045Medicaid
NY3354432OtherNABP
NY3354432OtherNABP
NY0767900001Medicare ID - Type Unspecified
NYG300079696Medicare PIN