Healthcare Provider Details

I. General information

NPI: 1184534646
Provider Name (Legal Business Name): VITORIA CONNECTICUT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 N MAIN ST
WEST HARTFORD CT
06117-2500
US

IV. Provider business mailing address

4601 SW 25TH PL
CAPE CORAL FL
33914-6144
US

V. Phone/Fax

Practice location:
  • Phone: 502-817-8620
  • Fax:
Mailing address:
  • Phone: 502-817-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS ROBERT RUSSELL
Title or Position: CEO
Credential: RPH
Phone: 502-817-8620