Healthcare Provider Details

I. General information

NPI: 1427052844
Provider Name (Legal Business Name): MACKENZIES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 WHITE PLAINS RD
TRUMBULL CT
06611-4550
US

IV. Provider business mailing address

19 BLACKBERRY RD
TRUMBULL CT
06611-3981
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-2541
  • Fax: 203-268-5836
Mailing address:
  • Phone: 203-261-2541
  • Fax:

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 Number208
License Number StateCT

VIII. Authorized Official

Name: PAT SANTELLA
Title or Position: OWNER MANAGER
Credential: RPH
Phone: 203-261-2541