NPIMap

Organization Active NPI

Graeber'S Pharmacy Inc

  • Community/Retail Pharmacy
  • Meriden, CT
National Provider Identifier
1528076189
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
416 Issued in CT
Legal business name
GRAEBER'S PHARMACY INC
Practice address
172 W Main St
Meriden, CT 06451-4104
Phone
(203) 235-6305
Fax
(203) 235-0244
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2020

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

Authorized official

Name
Mr. Roger C Dezinno
Title
VP
Phone
(203) 235-6305

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X
Community/Retail Pharmacy 3336C0003X 416 CT Primary

Addresses

Primary practice location

172 W Main St
Meriden, CT 06451-4104

Mailing address

172 W Main St
Meriden, CT 06451-4104
Phone (203) 235-6305

Other identifiers 2

IdentifierTypeStateIssuer
004028114MedicaidCT
004016515MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930081899 CT DME Supplier - PharmacyDME Supplier - Orthotic Personnel 7719005461 Practice locations: Meriden, CT

National Provider Directory

National Provider Directory
Tax ID family
Graeber'S Pharmacy Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588636800000",
    "number": "1528076189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 W MAIN ST",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064514104",
            "telephone_number": "203-235-6305",
            "fax_number": "203-235-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 W MAIN ST",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064514104",
            "telephone_number": "203-235-6305",
            "fax_number": "203-235-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAEBER'S PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A",
        "authorized_official_last_name": "DEZINNO",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "203-235-6305",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004028114",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004016515",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meriden, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2020; 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.