Healthcare Provider Details

I. General information

NPI: 1548649155
Provider Name (Legal Business Name): BTE III INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 GREENWICH AVE
GREENWICH CT
06830
US

IV. Provider business mailing address

116 GREENWICH AVE
GREENWICH CT
06830
US

V. Phone/Fax

Practice location:
  • Phone: 203-661-1064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY.0002186
License Number StateCT

VIII. Authorized Official

Name: SUSANA GEROV
Title or Position: PRES.
Credential:
Phone: 203-661-1064