Suburban Pharmacy LTC Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

2051 Issued in CT

Legal business name

SUBURBAN PHARMACY LTC INC

Doing business as

SUBURBAN PHARMACY LTC INC

Practice address

342 N Main St
Ste 70
West Hartford, CT 06117-2500

Phone

(860) 882-1808

Fax

(860) 882-1791

NPI assigned

Feb 28, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Ratna Kumar Kammuluri, RPH

Title

Pharmacist

Phone

(860) 882-1808

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• SUBURBAN PHARMACY LTC INC Doing business as

Medicare fee-for-service enrollment

Enrolled in CT2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rudy Dajie, PHARM D

  • Pharmacist
  • West Hartford, CT
  • NPI 1972808087
  NPD (past)
• Sangeetha Kusa, RPH

  • Pharmacist
  • West Hartford, CT
  • NPI 1427836170
  NPD (past)

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1932236775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 N MAIN ST",
            "address_2": "STE 70",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172500",
            "telephone_number": "860-882-1808",
            "fax_number": "860-882-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 N MAIN ST",
            "address_2": "STE 70",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172500",
            "telephone_number": "860-882-1808",
            "fax_number": "860-882-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN PHARMACY LTC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "KAMMULURI",
        "authorized_official_first_name": "RATNA KUMAR",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "860-882-1808",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "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": "2051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0720690",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUBURBAN PHARMACY LTC INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hector J Suazo, DMD
• Suburban Home Medical Inc
• Suburban Home Medical, Inc
• Suburban Pharma Inc
• Suburban Pharma Inc
• Leonard C Suchotliff, PHD
• Amanda Kate Sullivan
• Emily Sullivan
• Emily Ricker Sullivan, M ED., BCBA
• Sullivan, Lemay & Associates Behavioral Health & Wellness LLC

• Long Term Care Pharmacy in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Long Term Care Pharmacy in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.