Healthcare Provider Details

I. General information

NPI: 1295740892
Provider Name (Legal Business Name): KENNETH MEADY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MAIN ST S
BETHLEHEM CT
06751-2004
US

IV. Provider business mailing address

95 MAIN ST S PO BOX 9
BETHLEHEM CT
06751-2004
US

V. Phone/Fax

Practice location:
  • Phone: 203-266-7801
  • Fax: 203-266-5321
Mailing address:
  • Phone: 203-266-7801
  • Fax: 203-266-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY.0001133
License Number StateCT

VIII. Authorized Official

Name: LESLIE MEADY
Title or Position: OWNER
Credential:
Phone: 203-266-7801