Healthcare Provider Details

I. General information

NPI: 1104876036
Provider Name (Legal Business Name): OXFORD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OXFORD RD
OXFORD CT
06478-1990
US

IV. Provider business mailing address

100 OXFORD RD
OXFORD CT
06478-1990
US

V. Phone/Fax

Practice location:
  • Phone: 203-888-4567
  • Fax: 203-888-6625
Mailing address:
  • Phone: 203-888-4567
  • Fax: 203-888-6625

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.0000392
License Number StateCT

VIII. Authorized Official

Name: FRANK DIAFERIO
Title or Position: V PRES
Credential: RPH
Phone: 203-888-4567