NPIMap

Organization Active NPI

Fair Haven Community Health Clinic, Inc

Doing business as Grand Pharmacy

  • Community/Retail Pharmacy
  • Branford, CT
National Provider Identifier
1760051486
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC
Doing business as
Grand Pharmacy
Practice address
221 W Main St
Branford, CT 06405-4022
Phone
(203) 974-5365
Fax
(877) 580-1279
NPI assigned
Jun 18, 2021
Last updated
May 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Authorized official

Name
Veena Kapadia
Title
Business Development Associate
Phone
(203) 777-7411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

221 W Main St
Branford, CT 06405-4022

Mailing address

374 Grand Ave
New Haven, CT 06513-3733
Phone (203) 974-5365

Other names 1

  • Grand Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240916002505 CT Part B Supplier - Pharmacy 4183511538 1 other NPI on this enrollment
Practice locations: New Haven, CT; Branford, CT
O20250214000649 CT Part B Supplier - Mass Immunization (Roster Biller Only) 4183511538 Practice locations: Branford, CT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Fair Haven Comm Health10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

118 Damascus Rd
Branford, CT 06405

14 Sycamore Way
Branford, CT 06405
Phone (203) 483-2630

23 Eades St
Branford, CT 06405

370 Hemingway Ave
East Haven, CT 06512
Phone (203) 468-1113

67 Hudson St
East Haven, CT 06512

100 James St
New Haven, CT 06513
Phone (203) 691-2017

1481 Quinnipiac Ave
New Haven, CT 06513

164 Grand Ave
New Haven, CT 06513
Phone (203) 691-2643

185 Barnes Ave
New Haven, CT 06513

293 Clinton Ave
New Haven, CT 06513
Phone (203) 691-3318

40 Albert St
Rm MC1
New Haven, CT 06511

Practitioners & affiliated clinicians

Practitioners 81

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.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683504000000",
    "number": "1760051486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 GRAND AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133733",
            "telephone_number": "203-974-5365",
            "fax_number": "877-580-1279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 W MAIN ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064054022",
            "telephone_number": "203-974-5365",
            "fax_number": "877-580-1279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR HAVEN COMMUNITY HEALTH CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-18",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A",
        "authorized_official_last_name": "KAPADIA",
        "authorized_official_first_name": "VEENA",
        "authorized_official_title_or_position": "BUSINESS DEVELOPMENT ASSOCIATE",
        "authorized_official_telephone_number": "203-777-7411"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Branford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; 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.