Healthcare Provider Details

I. General information

NPI: 1083012421
Provider Name (Legal Business Name): DIXWELL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 DIXWELL AVE
HAMDEN CT
06514-1847
US

IV. Provider business mailing address

2380 DIXWELL AVE
HAMDEN CT
06514-1847
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-6571
  • Fax:
Mailing address:
  • Phone: 203-281-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY.0001981
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPCY.0001981
License Number StateCT

VIII. Authorized Official

Name: MR. NAVEEN PARUPALLI
Title or Position: MEMBER
Credential: B.S.PHARMACY
Phone: 203-281-6571