Healthcare Provider Details

I. General information

NPI: 1235201997
Provider Name (Legal Business Name): BORDONARO'S PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 MAIN ST
PORTLAND CT
06480-1856
US

IV. Provider business mailing address

283 MAIN ST
PORTLAND CT
06480-1856
US

V. Phone/Fax

Practice location:
  • Phone: 860-342-3390
  • Fax: 860-342-3391
Mailing address:
  • Phone: 860-342-3390
  • Fax: 860-342-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number752
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number752
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number752
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number752
License Number StateCT

VIII. Authorized Official

Name: MR. JOSEPH E BORDONARO
Title or Position: OWNER MANAGER
Credential: RPH
Phone: 860-342-3390