Active NPI
Grace Park
- Pharmacist
- Uncasville, CT
National Provider Identifier
1265991830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PCT.14114
- Practice address
- 2005 Norwich New London Tpke
Uncasville, CT 06382-1369 - Phone
- (860) 848-3202
- NPI assigned
- Mar 13, 2019
- Last updated
- Mar 13, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PCT.14114 | CT | Primary |
Addresses
Primary practice location
2005 Norwich New London Tpke
Uncasville, CT 06382-1369
Mailing address
87 Strawberry St
Lisbon, CT 06351-2837
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.14114 | CT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connecticut CVS Pharmacy, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552435200000",
"number": "1265991830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "87 STRAWBERRY ST",
"city": "LISBON",
"state": "CT",
"postal_code": "063512837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 NORWICH NEW LONDON TPKE",
"city": "UNCASVILLE",
"state": "CT",
"postal_code": "063821369",
"telephone_number": "860-848-3202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-13",
"last_updated": "2019-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "PCT.14114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Uncasville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.