MAIN STREET PHARMACY 3 LLC NPI 1780182766

NPI Information

MAIN STREET PHARMACY 3 LLC is a long term care pharmacy pharmacy in Bridgeport, CT. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. MAIN STREET PHARMACY 3 LLC NPI is 1780182766. The provider is registered as an organization entity type.
The provider Is Doing Business As Main Street Pharmacy.

The provider's business location address is:

2117 BOSTON AVE
BRIDGEPORT, CT
ZIP 06610-030
Phone: (203) 212-3800
Fax: (203) 212-3802

The provider's authorized official is Jean Jacob .
The authorized official title is Member and has the following contact phone number (203) 212-3800.

The CLIA number assigned to this NPI record is 07D2119191 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/25/2018 and was last updated on 1/25/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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