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General NPI Number Information
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NPI Number | 1174982730
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Entity Type | Organization
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Legal Business Name | ALC PHARMCARE
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 1330 SULLIVAN AVE
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2771
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Country | US
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Telephone | 860-648-9755
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Fax | 860-648-9756
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Provider Business Mailing Address
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Address Line | 1330 SULLIVAN AVE
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2771
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Country | US
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Telephone | 860-648-9755
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Fax | 860-648-9756
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Authorized Official
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Title or Position | CEO
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Name | DR. LORI CALABRESE
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Credential | M.D.
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Telephone | 860-648-9755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 035645
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License Number State | CT
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