Killingworth Family Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PCY.0002196 Issued in CT

Legal business name

KILLINGWORTH FAMILY PHARMACY INC

Practice address

183 Route 81 Ste 3
Killingworth, CT 06419-1480

Phone

(860) 452-4275

Fax

(860) 452-4278

NPI assigned

Nov 24, 2010

Organization subpart

No

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

Authorized official

Name

Keith LykeNPI 1417535691

Title

Owner / Phcy MGR

Phone

(860) 452-4275

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Killingworth Family Pharmacy inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keith D Lyke, RPH

  • Pharmacist
  • Killingworth, CT
  • NPI 1417535691
  NPD Authorized official

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

{
    "created_epoch": "1290556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1386946366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "183 ROUTE 81 STE 3",
            "city": "KILLINGWORTH",
            "state": "CT",
            "postal_code": "064191480",
            "telephone_number": "860-452-4275",
            "fax_number": "860-452-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 ROUTE 81 STE 3",
            "city": "KILLINGWORTH",
            "state": "CT",
            "postal_code": "064191480",
            "telephone_number": "860-452-4275",
            "fax_number": "860-452-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILLINGWORTH FAMILY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-24",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "LYKE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "OWNER / PHCY MGR",
        "authorized_official_telephone_number": "860-452-4275"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "PCY.0002196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008025521",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2127689",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Killingworth Family Pharmacy inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Georgios D Giambanis, PHARMACIST
• Emma Gulick, LMSW
• Justine Elise Jarvie, ASSOCIATE LMFT
• Kimberly Doyle Joyner, LMFT
• Killingworth Ambulance Association, Inc
• Jessie Larson, M.D.
• Rachael K. Leombruno, LMFT
• Keith D Lyke, RPH
• Mandy Major, PCD
• Jennifer Ann Mandeville, OTR/L

• All providers in Killingworth, CT
• Community/Retail Pharmacy in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.