=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811106461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRIFFIN PHARMACY & GIFTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 06/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 DIVISION ST
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06418-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-732-1490
-----------------------------------------------------
Fax | 203-732-1452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 DIVISION ST
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06418-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-732-1490
-----------------------------------------------------
Fax | 203-732-1452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER-PHARMACIST
-----------------------------------------------------
Name | MRS. BARBARA FERGUSON
-----------------------------------------------------
Credential | PD
-----------------------------------------------------
Telephone | 203-732-1490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 4819
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 1711
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------