MEDICARE: WESTON PHARMACY LLC

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	351	CT

General Provider Information

NPI Number	:	1609984921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTON PHARMACY LLC

Provider Business Mailing Address
First Line	:	190 WESTON RD
Second Line	:
City	:	WESTON
State	:	CT
Zip	:	06883-2126
Country	:	US
Telephone Number	:	203-226-1083
Fax Number	:	203-222-9380

Provider Business Practice Location Address
First Line	:	190 WESTON RD
Second Line	:
City	:	WESTON
State	:	CT
Zip	:	06883-2126
Country	:	US
Telephone Number	:	203-226-1083
Fax Number	:	203-222-9380

Authorized Official
Title or Position	:	MEMBER
Name	:	JONATHAN SPEICHER
Credential	:	RPH
Telephone Number	:	203-226-1083

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	08/22/2020

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