Healthcare Provider Details

I. General information

NPI: 1285749721
Provider Name (Legal Business Name): PETER SQUARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MILL ST
UNIONVILLE CT
06085-1000
US

IV. Provider business mailing address

30 MILL ST
UNIONVILLE CT
06085-1000
US

V. Phone/Fax

Practice location:
  • Phone: 860-673-3219
  • Fax: 860-673-1646
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0786
License Number StateCT

VIII. Authorized Official

Name: PETER GRIFFIN
Title or Position: PRESIDENT
Credential: RPH
Phone: 860-673-3219