Healthcare Provider Details

I. General information

NPI: 1780963603
Provider Name (Legal Business Name): WASHINGTON HEALTH CENTER & PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BRYAN HALL PLAZA
WASHINGTON DEPOT CT
06794
US

IV. Provider business mailing address

PO BOX 337
WASHINGTON DEPOT CT
06794-0337
US

V. Phone/Fax

Practice location:
  • Phone: 860-619-0251
  • Fax: 860-619-0700
Mailing address:
  • Phone: 860-619-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCY0002216
License Number StateCT

VIII. Authorized Official

Name: PAUL LUKOMSKI
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 860-619-0251