=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932862463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNECTICUT VALLEY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2021
-----------------------------------------------------
Last Update Date | 10/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 VINE STREET BLUE HILLS HOSPITAL
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-293-6410
-----------------------------------------------------
Fax | 860-293-6454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 351
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-7023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-262-6130
-----------------------------------------------------
Fax | 860-262-6159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY SUPERVISOR
-----------------------------------------------------
Name | MR. PAUL BARRY
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 860-262-6130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------