Healthcare Provider Details

I. General information

NPI: 1801348214
Provider Name (Legal Business Name): GRANBY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HARTFORD AVENUE
GRANBY CT
06035
US

IV. Provider business mailing address

9 HARTFORD AVENUE
GRANBY CT
06035
US

V. Phone/Fax

Practice location:
  • Phone: 860-653-2517
  • Fax: 860-653-2069
Mailing address:
  • Phone: 860-653-2517
  • Fax: 860-653-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AKASH PATEL
Title or Position: MEMBER
Credential:
Phone: 732-331-5965