Provider Demographics
NPI:1952061939
Name:PHARMACYATBBSQUARE LLC
Entity Type:Organization
Organization Name:PHARMACYATBBSQUARE LLC
Other - Org Name:PHARMACY AT BLUE BACK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAUROV
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-656-6229
Mailing Address - Street 1:55 ISHAM RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2205
Mailing Address - Country:US
Mailing Address - Phone:860-656-6229
Mailing Address - Fax:860-968-0013
Practice Address - Street 1:55 ISHAM RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2205
Practice Address - Country:US
Practice Address - Phone:860-656-6229
Practice Address - Fax:860-968-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-18
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy