Healthcare Provider Details

I. General information

NPI: 1730202516
Provider Name (Legal Business Name): HARTFORD DISPENSARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MAIN ST
HARTFORD CT
06106-1824
US

IV. Provider business mailing address

345 MAIN ST
HARTFORD CT
06106-1824
US

V. Phone/Fax

Practice location:
  • Phone: 860-525-2181
  • Fax:
Mailing address:
  • Phone: 860-525-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberSA-0036
License Number StateCT

VIII. Authorized Official

Name: MR. PAUL MCLAUGHLIN
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 860-525-2181