Healthcare Provider Details

I. General information

NPI: 1073939336
Provider Name (Legal Business Name): PRICE CHOPPER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 STORRS ROAD
STORRS MANSFIELD CT
06268
US

IV. Provider business mailing address

461 NOTT ST MB#202
SCHENECTADY NY
12308-1812
US

V. Phone/Fax

Practice location:
  • Phone: 860-553-6556
  • Fax: 860-477-1405
Mailing address:
  • Phone: 518-379-1618
  • Fax: 518-356-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY.0002293
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN BRYANT
Title or Position: VP OF PHARMACY
Credential:
Phone: 518-379-1122