Connecticut Pharmacy East Rock LTC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PCY0002218 Issued in CT

Legal business name

CONNECTICUT PHARMACY EAST ROCK LTC

Practice address

10 Fairfield Blvd Unit C2
Wallingford, CT 06492-5903

Phone

(203) 691-5405

Fax

(203) 691-5107

NPI assigned

Jul 15, 2011

Last updated

Jun 22, 2020By 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

Scott WolakNPI 1639768468

Title

RPH/President

Phone

(203) 518-1146

Specialties & licenses 6

Addresses

Other identifiers 2

Other names 1

• East Rock Pharmacy Former legal business name

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Tax ID family

Connecticut Pharmacy East Rock LTC2 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.

• East Rock Pharmacy, LLC

  • Durable Medical Equipment & Medical Supplies
  • New Haven, CT
  • NPI 1164764213
  NPD tax ID

Locations

Practitioners 3

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.

• Scott Wolak, RPH

  • Pharmacist
  • Norwalk, CT
  • NPI 1639768468
  Authorized official Same address or phone
• Olivia Chui Sang Lau, PHARMD

  • Pharmacist
  • Wallingford, CT
  • NPI 1609469485
  NPD
• Robert S Zirlis, RPH

  • Pharmacist
  • Wallingford, CT
  • NPI 1609467273
  NPD

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592784000000",
    "number": "1740578335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 FAIRFIELD BLVD",
            "address_2": "UNIT C",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064925903",
            "telephone_number": "203-691-5405",
            "fax_number": "203-691-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 FAIRFIELD BLVD UNIT C2",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064925903",
            "telephone_number": "203-691-5405",
            "fax_number": "203-691-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT PHARMACY EAST ROCK LTC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-15",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A",
        "authorized_official_last_name": "WOLAK",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "RPH/PRESIDENT",
        "authorized_official_telephone_number": "203-518-1146"
    },
    "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CT",
            "license": "PCY0002218",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008033891",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2131131",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAST ROCK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Rock Pharmacy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.