Active NPI
Phong Kieu
- Pharmacist
- Newington, CT
National Provider Identifier
1861923336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13999
- Practice address
- 2286 Berlin Tpke
Newington, CT 06111-3202 - Phone
- (860) 343-5220
- Fax
- (860) 343-5230
- NPI assigned
- Mar 25, 2017
- Last updated
- Jan 17, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13999 | CT | Primary |
Addresses
Primary practice location
2286 Berlin Tpke
Newington, CT 06111-3202
Mailing address
2286 Berlin Tpke
Newington, CT 06111-3202
Phone (860) 343-5220
Other practice location 1
40 East St
New Milford, CT 06776-3014
Phone (860) 354-4455
Other practice location 2
215 West St
Seymour, CT 06483-2640
Phone (203) 888-9068
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13999 | CT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nostrumrx LLC | Past | Accepting new patients | |
| Connecticut CVS Pharmacy LLC | Past | Accepting new patients | |
| Connecticut CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Retail Pharmacy
- Newington, CT
- NPI 1093204604
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737072000000",
"number": "1861923336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2286 BERLIN TPKE",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "061113202",
"telephone_number": "860-343-5220",
"fax_number": "860-343-5230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2286 BERLIN TPKE",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "061113202",
"telephone_number": "860-343-5220",
"fax_number": "860-343-5230"
}
],
"practiceLocations": [
{
"address_1": "40 East St",
"address_purpose": "LOCATION",
"city": "New Milford",
"state": "CT",
"postal_code": "067763014",
"country_code": "US",
"telephone_number": "860-354-4455",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "215 West St",
"address_purpose": "LOCATION",
"city": "Seymour",
"state": "CT",
"postal_code": "064832640",
"country_code": "US",
"telephone_number": "203-888-9068",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KIEU",
"first_name": "PHONG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-25",
"last_updated": "2025-01-17",
"certification_date": "2025-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "13999",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.