Main Street Pharmacy 4 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PCY.0002185 Issued in CT

Legal business name

MAIN STREET PHARMACY 4 LLC

Doing business as

Main Street Pharmacy

Practice address

166 W Broad St
Stamford, CT 06902-3661

Phone

(203) 870-9902

Fax

(203) 870-9903

NPI assigned

Aug 12, 2010

Last updated

Aug 23, 2011By 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

Jean Jacob

Title

Owner

Phone

(203) 870-9902

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": "1281571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314057600000",
    "number": "1689989782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 W BROAD ST",
            "address_2": "SUITE# G1",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069023661",
            "telephone_number": "203-883-8700",
            "fax_number": "203-883-8702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 W BROAD ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069023661",
            "telephone_number": "203-870-9902",
            "fax_number": "203-870-9903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PHARMACY 4 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-12",
        "last_updated": "2011-08-23",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-870-9902"
    },
    "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.0002185",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0722062",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Safiah Maharaj, LPCA
• Theresa R Mahon, MD
• Allyson Mahoney, M.S., CCC/SLP
• Jin Yan Mai-Soto, DDS
• Annette Marie Maiberger, LCSW
• Robert L Maiolo, O.D.
• Jonathan M Mak
• Jennifer Landesman Makadok, LCSW
• Makar Dental LLC
• Andriyana Makar

• Community/Retail Pharmacy in Stamford, CT
• Providers in Stamford, 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 Aug 23, 2011; 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.