Healthcare Provider Details

I. General information

NPI: 1265547475
Provider Name (Legal Business Name): HEBRON PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MAIN ST
HEBRON CT
06248-1519
US

IV. Provider business mailing address

PO BOX 155
HEBRON CT
06248-0155
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-3888
  • Fax: 860-228-3391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY.0001062
License Number StateCT

VIII. Authorized Official

Name: HAYDEN HOUSTON
Title or Position: PRESIDENT
Credential:
Phone: 860-228-3888