Healthcare Provider Details

I. General information

NPI: 1033190806
Provider Name (Legal Business Name): CANDLEWOOD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RT 37 BOX 8874
NEW FAIRFIELD CT
06812
US

IV. Provider business mailing address

11 RT 37 BOX 8874
NEW FAIRFIELD CT
06812
US

V. Phone/Fax

Practice location:
  • Phone: 203-746-2404
  • Fax: 203-746-2269
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1040
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID MASTERANTUONE
Title or Position: PRES
Credential:
Phone: 203-746-2404