Main Street Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MAIN STREET PHARMACY INC

Practice address

421 Park St
Hartford, CT 06106-1534

Phone

(860) 200-0909

Fax

(860) 200-0707

NPI assigned

Jan 16, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Raveendra Reddy Bommu

Title

President

Phone

(203) 919-3124

Specialties & licenses 1

Addresses

Other names 1

• main street pharmacy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1154895837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 PARK ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061534",
            "telephone_number": "860-200-0909",
            "fax_number": "860-200-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 PARK ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061534",
            "telephone_number": "860-200-0909",
            "fax_number": "860-200-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "BOMMU",
        "authorized_official_first_name": "RAVEENDRA",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-919-3124",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "main street pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "main street pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Xingchen Mai, M.D.
• Cheryl Diane Maida, LCSW
• Anthony Maietta, MSPT
• Robert J Mailloux, D.M.D.
• Todd Warren Mailly, MD
• Urmila Mainali, FNP-C
• Maison Care LLC
• Malgorzata Majewski
• Valerie Dominique Majewski, MA, LPC
• Laura D Majidian, LCSW

• Community/Retail Pharmacy in Hartford, CT
• Providers in Hartford, CT by specialty
• Community/Retail Pharmacy in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.