Healthcare Provider Details

I. General information

NPI: 1467302992
Provider Name (Legal Business Name): WASSEF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HALLS RD
OLD LYME CT
06371-4406
US

IV. Provider business mailing address

90 HALLS RD
OLD LYME CT
06371-4406
US

V. Phone/Fax

Practice location:
  • Phone: 860-339-5667
  • Fax: 860-339-5796
Mailing address:
  • Phone: 860-339-5667
  • Fax: 860-339-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NAGY WASSEF
Title or Position: MEMBER
Credential: RPH
Phone: 860-339-5667