Provider Demographics
NPI:1538193891
Name:PLANTSVILLE PHARMACY INC.
Entity type:Organization
Organization Name:PLANTSVILLE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MANAGER, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:POTREPKA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-628-2385
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1522
Mailing Address - Country:US
Mailing Address - Phone:860-628-2382
Mailing Address - Fax:
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1522
Practice Address - Country:US
Practice Address - Phone:860-628-2382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0130130001Medicare ID - Type Unspecified