Healthcare Provider Details

I. General information

NPI: 1982908620
Provider Name (Legal Business Name): STAMFORD RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 HIGH RIDGE RD
STAMFORD CT
06905
US

IV. Provider business mailing address

1055 HIGH RIDGE RD
STAMFORD CT
06905
US

V. Phone/Fax

Practice location:
  • Phone: 203-883-8484
  • Fax: 203-883-8486
Mailing address:
  • Phone: 203-883-8484
  • Fax: 203-883-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY.0002198
License Number StateCT

VIII. Authorized Official

Name: MR. MITCHELL MIGDEN
Title or Position: PRES
Credential: RPH
Phone: 203-883-8484