Provider Demographics
NPI:1316062904
Name:PIONEER HEALTH COMPOUNDING PHARMCACY
Entity type:Organization
Organization Name:PIONEER HEALTH COMPOUNDING PHARMCACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-979-0089
Mailing Address - Street 1:520 HARTFORD TPKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5037
Mailing Address - Country:US
Mailing Address - Phone:860-979-0089
Mailing Address - Fax:860-989-0091
Practice Address - Street 1:520 HARTFORD TPKE
Practice Address - Street 2:SUITE D
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5037
Practice Address - Country:US
Practice Address - Phone:860-979-0089
Practice Address - Fax:860-989-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.18283336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy