Healthcare Provider Details

I. General information

NPI: 1144152281
Provider Name (Legal Business Name): EJ VENTURES 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 COMMERCE DR
BRIDGEPORT CT
06605-2231
US

IV. Provider business mailing address

2000 COMMERCE DR
BRIDGEPORT CT
06605-2231
US

V. Phone/Fax

Practice location:
  • Phone: 203-530-8885
  • Fax:
Mailing address:
  • Phone: 203-530-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAY PANTALENA
Title or Position: MANAGER
Credential:
Phone: 203-530-8885