Healthcare Provider Details

I. General information

NPI: 1245560853
Provider Name (Legal Business Name): MAIN STREET PHARMACY 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MAIN ST STE 7
DANBURY CT
06810-5847
US

IV. Provider business mailing address

345 MAIN ST STE 7
DANBURY CT
06810-5847
US

V. Phone/Fax

Practice location:
  • Phone: 203-297-6130
  • Fax: 203-297-6132
Mailing address:
  • Phone: 203-297-6130
  • Fax: 203-297-6132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPCY.0002154
License Number StateCT

VIII. Authorized Official

Name: DR. JUSTIN JAMES BUTURLA
Title or Position: OWNER
Credential: PHARMD
Phone: 203-297-6130