Provider Demographics
NPI:1609612928
Name:JEWETT CITY PHARMACY
Entity type:Organization
Organization Name:JEWETT CITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOMARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-764-4688
Mailing Address - Street 1:78 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEWETT CITY
Mailing Address - State:CT
Mailing Address - Zip Code:06351-2226
Mailing Address - Country:US
Mailing Address - Phone:860-376-4468
Mailing Address - Fax:
Practice Address - Street 1:78 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEWETT CITY
Practice Address - State:CT
Practice Address - Zip Code:06351-2226
Practice Address - Country:US
Practice Address - Phone:860-376-4468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWETT CITY PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy