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General NPI Number Information
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NPI Number | 1598828873
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Entity Type | Organization
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Legal Business Name | HEALTH COMPLEX MEDICAL, LLC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 84 PROGRESS LN
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City | WATERBURY
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State | CT
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Zip | 06705-3829
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Country | US
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Telephone | 203-753-7778
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Fax | 203-346-7593
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Provider Business Mailing Address
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Address Line | 84 PROGRESS LN
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City | WATERBURY
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State | CT
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Zip | 06705-3829
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Country | US
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Telephone | 203-753-7778
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Fax | 203-346-7593
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | WENDY RUSSALESI
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Credential |
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Telephone | 484-246-9499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 6569
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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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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