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General NPI Number Information
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NPI Number | 1477574424
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Entity Type | Organization
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Legal Business Name | PHARMAGEN LABORATORIES
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 30 BUXTON FARMS ROAD SUITE 110
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City | STAMFORD
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State | CT
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Zip | 06905
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Country | US
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Telephone | 203-359-6323
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Fax | 203-359-6448
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Provider Business Mailing Address
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Address Line | 30 BUXTON FARMS ROAD SUITE 110
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City | STAMFORD
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State | CT
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Zip | 06905
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Country | US
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Telephone | 203-359-6323
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Fax | 203-359-6448
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. JUSTIN BARCH
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Credential |
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Telephone | 301-455-0207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PCY0001773
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PCY.0001773
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License Number State | CT
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