Provider Demographics
NPI:1285087650
Name:TRUMBULL PHARMACY LLC
Entity type:Organization
Organization Name:TRUMBULL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-590-7555
Mailing Address - Street 1:10 BROADWAY RD,
Mailing Address - Street 2:BLDG B, UNIT B
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1812
Mailing Address - Country:US
Mailing Address - Phone:203-590-7555
Mailing Address - Fax:
Practice Address - Street 1:10 BROADWAY ROAD, BLDG B, UNIT B
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-590-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy