MEDICARE: BURGDORF PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		CT
2	335E00000X	Prosthetic/Orthotic Supplier		CT
3	3336L0003X	Long Term Care Pharmacy	01571	CT
4	332BC3200X	Customized Equipment (DME)		CT
5	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)		CT
6	332BX2000X	Oxygen Equipment & Supplies (DME)		CT
7	3336C0003X	Community/Retail Pharmacy	01571	CT
8	3336C0004X	Compounding Pharmacy	01571	CT
9	3336H0001X	Home Infusion Therapy Pharmacy	01571	CT
10	3336I0012X	Institutional Pharmacy	01571	CT
11	3336M0002X	Mail Order Pharmacy	01571	CT
12	3336M0003X	Managed Care Organization Pharmacy	01571	CT
13	3336S0011X	Specialty Pharmacy	01571	CT
14	333600000X	Pharmacy	01571	CT
15	3336C0002X	Clinic Pharmacy	01571	CT

General Provider Information

NPI Number	:	1063410389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURGDORF PHARMACY INC

Provider Business Mailing Address
First Line	:	500 FARMINGTON AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-3106
Country	:	US
Telephone Number	:	860-570-0543
Fax Number	:	560-570-0529

Provider Business Practice Location Address
First Line	:	131 COVENTRY STREET
Second Line	:	2ND FL
City	:	HARTFORD
State	:	CT
Zip	:	06112
Country	:	US
Telephone Number	:	860-286-2766
Fax Number	:	860-286-2981

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	ANGELO DEFAZIO
Credential	:	RPH PD
Telephone Number	:	860-570-0543

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	09/11/2025

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