Healthcare Provider Details

I. General information

NPI: 1285348979
Provider Name (Legal Business Name): ROTARY APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BARNUM AVE
STRATFORD CT
06614-4985
US

IV. Provider business mailing address

1030 BARNUM AVE
STRATFORD CT
06614-4985
US

V. Phone/Fax

Practice location:
  • Phone: 203-378-9394
  • Fax: 203-375-8651
Mailing address:
  • Phone: 203-378-9394
  • Fax: 203-375-8651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VENUMADHAV CHALUVADI
Title or Position: MEMBER
Credential:
Phone: 973-885-2793