Provider Demographics
NPI:1871953471
Name:GRAEBER'S PHARMACY INC
Entity type:Organization
Organization Name:GRAEBER'S PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND SEC
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEZINNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-235-6305
Mailing Address - Street 1:172 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-4104
Mailing Address - Country:US
Mailing Address - Phone:203-235-6305
Mailing Address - Fax:
Practice Address - Street 1:172 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-4104
Practice Address - Country:US
Practice Address - Phone:203-235-6305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY0000416332B00000X, 332BP3500X, 333600000X, 3336C0003X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier