Provider Demographics
NPI:1871691360
Name:L & R GROUP, INC.
Entity type:Organization
Organization Name:L & R GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROTONDO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:203-367-7979
Mailing Address - Street 1:4699 MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1830
Mailing Address - Country:US
Mailing Address - Phone:203-367-7979
Mailing Address - Fax:203-367-6780
Practice Address - Street 1:4699 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1830
Practice Address - Country:US
Practice Address - Phone:203-367-7979
Practice Address - Fax:203-367-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CT11263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004144838Medicaid
CT1049380001Medicare ID - Type Unspecified