Nutmeg Pharmacy Moodus LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

NUTMEG PHARMACY MOODUS LLC

Doing business as

Nutmeg Pharmacy

Practice address

26 Falls Rd
Moodus, CT 06469-1262

Phone

(860) 891-8164

Fax

(860) 891-8313

NPI assigned

Dec 3, 2019

Last updated

Feb 7, 2023By 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

Gregory Edward McKenna, RPHNPI 1295100055

Title

Managing Member

Phone

(860) 345-3607

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nutmeg Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

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.

• Gregory McKenna

  • Pharmacist
  • Higganum, CT
  • NPI 1295100055
  Authorized official Same address or phone

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

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1932746591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 540",
            "city": "HIGGANUM",
            "state": "CT",
            "postal_code": "064410540",
            "telephone_number": "860-345-3607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 FALLS RD",
            "city": "MOODUS",
            "state": "CT",
            "postal_code": "064691262",
            "telephone_number": "860-891-8164",
            "fax_number": "860-891-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTMEG PHARMACY MOODUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-03",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "860-345-3607",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008092217",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nutmeg Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew Morris-Wood
• Nicole Muckenhirn
• Keith J Murphey, L.P.C
• Nathan Hale Pharmacy Inc
• Nutmeg Pharmacy Moodus LLC (Nutmeg Pharmacy)
• Steven M Pear, DMD
• Peoplesdental, P.C. (East Haddam Dental Associates)
• Christopher Petersen, R.N.
• Alexandra Pires
• Lisa Beth Rogers, LCSW

• Community/Retail Pharmacy in Moodus, CT
• Providers in Moodus, CT by specialty
• Community/Retail Pharmacy in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.