Provider Demographics
NPI:1881793776
Name:SLAVINS-HANCOCK PHARMACY, INC
Entity type:Organization
Organization Name:SLAVINS-HANCOCK PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUDIPEDDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-323-2161
Mailing Address - Street 1:922 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2204
Mailing Address - Country:US
Mailing Address - Phone:203-323-2161
Mailing Address - Fax:203-964-1913
Practice Address - Street 1:922 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2204
Practice Address - Country:US
Practice Address - Phone:203-323-2161
Practice Address - Fax:203-964-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.0000767333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133461OtherPK
CT008036522Medicaid