Fair Haven Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

FAIR HAVEN PHARMACY LLC

Practice address

351 Grand Ave
New Haven, CT 06513-3732

Phone

(203) 923-3229

NPI assigned

Feb 20, 2024

Organization subpart

No

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

Authorized official

Name

Manthena Varma

Title

Member

Phone

(203) 923-3229

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1708387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1306601166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 GRAND AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133997",
            "telephone_number": "203-923-3229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 GRAND AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133732",
            "telephone_number": "203-923-3229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR HAVEN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "VARMA",
        "authorized_official_first_name": "MANTHENA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "203-923-3229"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fair Haven Community Health Clinic, Inc
• Fair Haven Community Health Clinic, Inc
• Fair Haven Community Health Clinic, Inc
• Fair Haven Community Health Clinic, Inc
• Fair Haven Dental LLC
• Barbara Jean Fair, LCSW
• Susan Fair, P.A.-C.
• Melissa Gerardi Fairbairn, PA-C
• Victoria Christine Fairchild, MD
• Elaine C. Fajardo, M.D.

• Community/Retail Pharmacy in New Haven, CT
• Providers in New Haven, 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 Feb 20, 2024; 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.