Durham Pharmco Inc
Organization Active NPI Community/Retail Pharmacy · Durham, CT
NPI 1235146804 · NPPES record last updated Nov 29, 2016
Key facts
- NPI
- 1235146804
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PCY0000191 (CT)
- Legal business name
- DURHAM PHARMCO INC
- Practice address
- 321 Main St
Durham, CT 06422-1614 - Phone
- (860) 349-3478
- Fax
- (860) 349-1240
- NPI assigned
- Aug 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Walter Douglass, RPH
- Title
- President
- Phone
- (860) 349-3478
Practitioners 2
-
Susan Marie Palmer, RPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131210000674 | CT | Part B Supplier - Mass Immunization (Roster Biller Only) | 3577790955 | Practice locations: Durham, CT |
| O20201029001627 | CT | Part B Supplier - Pharmacy | 3577790955 | Practice locations: Durham, CT |
National Provider Directory
Locations
321 Main St
Durham, CT 06422
Phone (860) 349-3478
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PCY0000191 | CT | Yes |
Addresses
Primary practice location
321 Main St
Durham, CT 06422-1614
Mailing address
321 Main St
Durham, CT 06422-1614
Phone (860) 349-3478
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004093481 | Medicaid | CT | |
| 1999590 | Other | PK |
Other names
- DURHAM HEALTHMART PHARMACY
Other providers in Durham, CT
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All providers in Durham, 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 Nov 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.