Provider Demographics
NPI:1104876036
Name:OXFORD PHARMACY INC
Entity type:Organization
Organization Name:OXFORD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V PRES
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAFERIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-888-4567
Mailing Address - Street 1:100 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1990
Mailing Address - Country:US
Mailing Address - Phone:203-888-4567
Mailing Address - Fax:203-888-6625
Practice Address - Street 1:100 OXFORD RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1990
Practice Address - Country:US
Practice Address - Phone:203-888-4567
Practice Address - Fax:203-888-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY.00003923336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1999430OtherPK
CT4082913Medicaid
1999430OtherPK