Higganum Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PCY.0002191 Issued in CT

Legal business name

HIGGANUM PHARMACY LLC

Doing business as

Nutmeg Pharmacy

Practice address

23 Killingworth Rd
Higganum, CT 06441-4242

Phone

(860) 345-3607

Fax

(860) 345-3611

NPI assigned

Sep 3, 2010

Organization subpart

No

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

Authorized official

Name

Gregory McKennaNPI 1295100055

Title

Managing Member

Phone

(860) 345-3607

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Nutmeg Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CT3 enrollments

Enrollment records 3

Tax ID family

Higganum Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Higganum Pharmacy LLC

  • Long Term Care Pharmacy
  • Higganum, CT
  • NPI 1679195481
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gregory McKenna

  • Pharmacist
  • Higganum, CT
  • NPI 1295100055
  Authorized official Same address or phone

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

{
    "created_epoch": "1283472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1447567961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 540",
            "city": "HIGGANUM",
            "state": "CT",
            "postal_code": "064410540",
            "telephone_number": "860-345-3607",
            "fax_number": "860-345-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 KILLINGWORTH RD",
            "city": "HIGGANUM",
            "state": "CT",
            "postal_code": "064414242",
            "telephone_number": "860-345-3607",
            "fax_number": "860-345-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGGANUM PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-03",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "860-345-3607"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "PCY.0002191",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00802487",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2126690",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nutmeg Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittany Farrell
• Amberlyn Grasso
• Michele Grasso, RPT
• Haddam Volunteer Ambulance Service Inc
• Higganum Drug Center
• Higganum Pharmacy LLC
• Higganum Physical Therapy, Inc.
• Julie Marie Huston, APRN
• Michael Kalinowski, M.D.
• Melissa Kovacs, LPC

• Community/Retail Pharmacy in Higganum, CT
• Providers in Higganum, 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 6, 2023; 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.