Healthcare Provider Details

I. General information

NPI: 1598223877
Provider Name (Legal Business Name): MAIN STREET PHARMACY 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
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 TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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