| NPI | 1265098719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDHYA R KANTAMANENI Member 860-522-9289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2019-05-09 |