Healthcare Provider Details

I. General information

NPI: 1609095868
Provider Name (Legal Business Name): DANIELSON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 A WESTCOTT RD
DANIELSON CT
06239
US

IV. Provider business mailing address

77 A WESTCOTT RD
DANIELSON CT
06239
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-6418
  • Fax: 860-779-2647
Mailing address:
  • Phone: 860-774-6418
  • Fax: 860-779-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2085
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0720739
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: ROBERT NETHERCOTE
Title or Position: PRESIDENT
Credential: RPH
Phone: 508-450-3161