=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578033569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNCAS PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2018
-----------------------------------------------------
Last Update Date | 12/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 TOWN ST
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-889-8413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 TOWN ST
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-889-8413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SANTHI KILARU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-889-8413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------