Bonneville RX LLC
Organization Active NPI Community/Retail Pharmacy · Danielson, CT
NPI 1164587580 · NPPES record last updated Sep 9, 2013
Key facts
- NPI
- 1164587580
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PCY0000159 (CT)
- Legal business name
- BONNEVILLE RX LLC
- Practice address
- 77 Westcott Rd
Danielson, CT 06239-2929 - Phone
- (860) 774-9362
- Fax
- (860) 779-2647
- NPI assigned
- Dec 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Ravinder Annamaneni
- Title
- Member
- Phone
- (860) 774-9362
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PCY0000159 | CT | Yes |
Addresses
Primary practice location
77 Westcott Rd
Danielson, CT 06239-2929
Mailing address
77 Westcott Rd
Danielson, CT 06239-2929
Phone (860) 774-9362
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2138266 | Other | PK |
Other names
- BONNEVILLE PHARMACY
Other providers in Danielson, CT
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- Callie Bennet
- Brittany Lee Besse
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- James L Boccuzzi
- Andrea M Brightman
- Rachel Elizabeth Brown
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- Iain A Bryson
- Lawrence Caffrey
All providers in Danielson, CT · Community/Retail Pharmacy in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.