Healthcare Provider Details

I. General information

NPI: 1699612226
Provider Name (Legal Business Name): 175 MAIN STREET PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MAIN ST
HARTFORD CT
06106-1818
US

IV. Provider business mailing address

269 POST ROAD, PMB 852258
FAIRFIELD CT
06824-6220
US

V. Phone/Fax

Practice location:
  • Phone: 860-856-9501
  • Fax: 860-856-9502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SANDRA JAMRON
Title or Position: MANAGER
Credential:
Phone: 917-921-5838