Healthcare Provider Details

I. General information

NPI: 1861656290
Provider Name (Legal Business Name): MCQUADES HOME INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CLARA DR
MYSTIC CT
06355-1957
US

IV. Provider business mailing address

10 CLARA DR
MYSTIC CT
06355-1957
US

V. Phone/Fax

Practice location:
  • Phone: 860-536-3349
  • Fax: 860-536-3451
Mailing address:
  • Phone: 860-536-3349
  • Fax: 860-536-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY0002117
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY MCQUADE
Title or Position: PRESIDENT
Credential:
Phone: 860-536-3349