Healthcare Provider Details

I. General information

NPI: 1154569481
Provider Name (Legal Business Name): COLUMBUS CHEMISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HOWARD AVE
NEW HAVEN CT
06519-2112
US

IV. Provider business mailing address

615 HOWARD AVE
NEW HAVEN CT
06519-2112
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-4447
  • Fax: 203-562-4448
Mailing address:
  • Phone: 203-562-4447
  • Fax: 203-562-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPCY2133
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY2133
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPCY2133
License Number StateCT

VIII. Authorized Official

Name: MR. CHANDRA S VIPPARLA
Title or Position: PHARMACY MANAGER
Credential:
Phone: 203-785-9001