Provider Demographics
NPI:1194099630
Name:DOYLES DOLLAR STORE LLC
Entity type:Organization
Organization Name:DOYLES DOLLAR STORE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-564-3330
Mailing Address - Street 1:733 NORWICH RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1737
Mailing Address - Country:US
Mailing Address - Phone:860-564-3330
Mailing Address - Fax:860-564-7256
Practice Address - Street 1:733 NORWICH RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1737
Practice Address - Country:US
Practice Address - Phone:860-564-3330
Practice Address - Fax:860-564-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY00022333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0722769OtherNCPDP PROVIDER IDENTIFICATION NUMBER