MEDICARE: THE WESTON CENTER PHARMACY LLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PCY.0002098	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2149256	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326443300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WESTON CENTER PHARMACY LLC

Provider Business Mailing Address
First Line	:	190 WESTON RD
Second Line	:
City	:	WESTON
State	:	CT
Zip	:	06883-2126
Country	:	US
Telephone Number	:	203-226-7800
Fax Number	:	203-226-9300

Provider Business Practice Location Address
First Line	:	190 WESTON RD
Second Line	:
City	:	WESTON
State	:	CT
Zip	:	06883-2126
Country	:	US
Telephone Number	:	203-226-7800
Fax Number	:	203-226-9300

Authorized Official
Title or Position	:	OFFICER
Name	:	FRANK RANDAZZO
Credential	:	PHARM.D.
Telephone Number	:	203-226-7800

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	01/30/2018

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