NPIMap

Organization Active NPI

Main Street Pharmacy 3 LLC

  • Long Term Care Pharmacy
  • Bridgeport, CT
National Provider Identifier
1780182766
Registry record updated Jan 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PCY2190 Issued in CT
Legal business name
MAIN STREET PHARMACY 3 LLC
Practice address
2117 Boston Ave
Bridgeport, CT 06610-3030
Phone
(203) 212-3800
Fax
(203) 212-3802
NPI assigned
Jan 25, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2018

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

Authorized official

Name
Jean Jacob
Title
Member
Phone
(203) 212-3800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X PCY2190 CT Primary

Addresses

Primary practice location

2117 Boston Ave
Bridgeport, CT 06610-3030

Mailing address

2117 Boston Ave
Bridgeport, CT 06610-3030
Phone (203) 212-3800

Other identifiers 2

IdentifierTypeStateIssuer
2170877OtherPK
008032995MedicaidCT

Other names 1

  • Main Street Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Main Street Pharmacy 3 LLC2 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.

NPI Registry JSON

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

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516838400000",
    "number": "1780182766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 BOSTON AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066103030",
            "telephone_number": "203-212-3800",
            "fax_number": "203-212-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 BOSTON AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066103030",
            "telephone_number": "203-212-3800",
            "fax_number": "203-212-3802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PHARMACY 3 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-25",
        "last_updated": "2018-01-25",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "203-212-3800"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CT",
            "license": "PCY2190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2170877",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008032995",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2018; 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.