My Fair Haven Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PCY.0002315 Issued in CT

Legal business name

MY FAIR HAVEN PHARMACY LLC

Doing business as

Fair Haven Pharmacy

Practice address

72 Grand Ave
New Haven, CT 06513

Phone

(203) 498-3479

Fax

(203) 498-8000

NPI assigned

Aug 24, 2015

Last updated

Apr 1, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Manthena V Varma

Title

Member

Phone

(203) 498-3479

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Fair Haven Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CT2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

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.

• Suneetha Jakka, R.PH.

  • Pharmacist
  • New Haven, CT
  • NPI 1871920918
  NPD
• Abish Thomas

  • Pharmacist
  • Haines City, FL
  • NPI 1780003491
  NPD

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1568839876",
    "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": "06513",
            "telephone_number": "203-498-3479",
            "fax_number": "203-498-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 GRAND AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06513",
            "telephone_number": "203-498-3479",
            "fax_number": "203-498-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY FAIR HAVEN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-24",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "VARMA",
        "authorized_official_first_name": "MANTHENA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "203-498-3479"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "PCY.0002315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "008064135",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008061384",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fair Haven Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sankar Muthukumar, MD
• Keiko Muto-Thompson
• Anna Ruth Mutschler
• Srinivas Babu Muvvala, M.D
• Mandar Deepak Muzumdar, MD
• Eileen Mydosh, RPH, MBA
• Jennifer Emily Myer, MD
• Amy Joy Myers, LCSW
• Christopher Myers, MD
• Deirdre Myers, LADC, CCDP

• 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 Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.