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General NPI Number Information
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NPI Number | 1457646796
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Entity Type | Organization
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Legal Business Name | BROOKFIELD MEDICAL/SURGICAL SUPPLIES, INC.
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 60 OLD NEW MILFORD RD SUITE 1B
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City | BROOKFIELD
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State | CT
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Zip | 06804-2430
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Country | US
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Telephone | 203-775-9040
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Fax | 203-775-9515
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Provider Business Mailing Address
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Address Line | PO BOX 801
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City | BROOKFIELD
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State | CT
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Zip | 06804-0801
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Country | US
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Telephone | 203-775-2580
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Fax | 203-740-9098
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES P CANGELOSI
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Credential | RPH
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Telephone | 203-775-9040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2065
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 2065
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 2065
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License Number State | CT
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