Provider Demographics
NPI:1194264820
Name:HARTFORD PHARMACY II INC
Entity type:Organization
Organization Name:HARTFORD PHARMACY II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DHULIPALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-270-8013
Mailing Address - Street 1:57 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2520
Mailing Address - Country:US
Mailing Address - Phone:860-244-2222
Mailing Address - Fax:860-244-2202
Practice Address - Street 1:57 PARK ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2520
Practice Address - Country:US
Practice Address - Phone:860-244-2222
Practice Address - Fax:860-244-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0724369OtherNCPDP
CT008072753Medicaid
2167253OtherPK
CTPCY.0002349OtherBOARD OF PHARMACY
CTPCY.0002349OtherBOARD OF PHARMACY