Healthcare Provider Details

I. General information

NPI: 1336127984
Provider Name (Legal Business Name): BRIDGEPORT CHEMISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 FAIRFIELD AVE
BRIDGEPORT CT
06605-1928
US

IV. Provider business mailing address

1407 FAIRFIELD AVE
BRIDGEPORT CT
06605-1928
US

V. Phone/Fax

Practice location:
  • Phone: 203-367-4571
  • Fax: 203-368-4872
Mailing address:
  • Phone: 203-367-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAJENDRA APPALANENI
Title or Position: PRESIDENT
Credential:
Phone: 917-568-9000