Main Street Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PCY0002147 Issued in CT

Legal business name

MAIN STREET PHARMACY LLC

Doing business as

Main Street Pharmacy

Practice address

1005 Main St # 1J
Bridgeport, CT 06604-4221

Phone

(203) 870-9901

Fax

(203) 870-9903

NPI assigned

Sep 4, 2009

Last updated

Nov 12, 2010By 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

Dr. Jean Jacob

Title

Owner

Phone

(914) 843-1881

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Main Street Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1252022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1609109842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAIN ST # 1J",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066044221",
            "telephone_number": "203-870-9901",
            "fax_number": "203-870-9903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAIN ST # 1J",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066044221",
            "telephone_number": "203-870-9901",
            "fax_number": "203-870-9903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-04",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-843-1881",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CT",
            "license": "PCY0002147",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0721577",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fritz Maignan, MS, NCC, LPC
• Jackson P Maille, MD
• Main Street Pediatrics, PC
• Main Street Pharmacy 3 LLC
• Main Street Pharmacy 3 LLC (Main Street Pharmacy)
• Kenneth Joseph Maiocco, M.D.
• Melinda Joan Maisano
• Jonathan Maisel, MD
• Frank Maisonet, REGISTER NURSE
• Karen Yvonne Maizincho

• Community/Retail Pharmacy in Bridgeport, CT
• Providers in Bridgeport, 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 Nov 12, 2010; 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.