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NPI Code Detail

MEDICARE: SSV PHARMACY 1

MEDICARE: SSV PHARMACY 1
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
13336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1609346576
Entity Type Code : Organization
Provider Name (Legal Business Name) : SSV PHARMACY 1
Provider Business Mailing Address
First Line : 500 FARMINGTON AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06105-3106
Country : US
Telephone Number : 860-570-0543
Fax Number : 860-570-0529
Provider Business Practice Location Address
First Line : 500 FARMINGTON AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06105-3106
Country : US
Telephone Number : 860-982-7303
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. SANDHYA KANTAMANENI
Credential :
Telephone Number : 860-522-9289
Provider Enumeration Date : 12/04/2018
Last Update Date : 02/24/2020

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Directions to “SSV PHARMACY 1 ” Practice Location

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