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General NPI Number Information
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NPI Number | 1396885836
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Entity Type | Organization
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Legal Business Name | BELLA VISTA PHARMACY INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 321 EASTERN ST
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City | NEW HAVEN
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State | CT
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Zip | 06513-2462
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Country | US
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Telephone | 203-467-1683
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Fax | 203-467-5888
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Provider Business Mailing Address
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Address Line | 321 EASTERN ST
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City | NEW HAVEN
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State | CT
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Zip | 06513-2462
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Country | US
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Telephone | 203-467-1683
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Fax | 203-467-5888
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | ROGER BEAUDOIN
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Credential |
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Telephone | 860-921-7210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PCY0001063
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License Number State | CT
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