MEDICARE: PETER SQUARE 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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	0786	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0711689	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1285749721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER SQUARE INC

Provider Business Mailing Address
First Line	:	30 MILL ST
Second Line	:
City	:	UNIONVILLE
State	:	CT
Zip	:	06085-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 MILL ST
Second Line	:
City	:	UNIONVILLE
State	:	CT
Zip	:	06085-1000
Country	:	US
Telephone Number	:	860-673-3219
Fax Number	:	860-673-1646

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER GRIFFIN
Credential	:	RPH
Telephone Number	:	860-673-3219

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	09/11/2025

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Directions to “PETER SQUARE INC ” Practice Location

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