MEDICARE: COLONIAL DRUGGISTS OF WESTPORT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PCY864	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1998904	OTHER		PK

General Provider Information

NPI Number	:	1255316139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL DRUGGISTS OF WESTPORT INC

Provider Business Mailing Address
First Line	:	611 POST RD E
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4548
Country	:	US
Telephone Number	:	203-227-9538
Fax Number	:	203-227-6581

Provider Business Practice Location Address
First Line	:	611 POST RD E
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-4548
Country	:	US
Telephone Number	:	203-227-9538
Fax Number	:	203-227-6581

Authorized Official
Title or Position	:	REG PHAR AND OWNER
Name	:	RUSSELL LEVINE
Credential	:	REG PHAR
Telephone Number	:	203-227-9538

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	09/19/2025

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