Active NPI
Justin Ma
- Pharmacist
- Bridgeport, CT
National Provider Identifier
1972121010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 063971
- Practice address
- 1407 Fairfield Ave
Bridgeport, CT 06605-1928 - Phone
- (203) 367-4571
- NPI assigned
- Jul 6, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 063971 | NY | Primary |
| Pharmacist | 183500000X | 15467 | CT |
Addresses
Primary practice location
1407 Fairfield Ave
Bridgeport, CT 06605-1928
Mailing address
1196 Old Country Rd
Riverhead, NY 11901-2066
Phone (631) 208-0239
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 |
|---|---|---|---|
| 15467 | CT | MD | Pharmacist |
| 063971 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Bridgeport Chemists, Inc. | Past | Accepting new patients | |
| Bridgeport Chemists Inc | Past | Accepting new patients |
Locations
1196 Old Country Rd
Riverhead, NY 11901
Phone (631) 208-0239
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Riverhead, NY
- NPI 1659324630
-
- Community/Retail Pharmacy
- Bridgeport, CT
- NPI 1619074010
-
- Long Term Care Pharmacy
- Bridgeport, CT
- NPI 1336127984
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768435200000",
"number": "1972121010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1196 OLD COUNTRY RD",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119012066",
"telephone_number": "631-208-0239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1407 FAIRFIELD AVE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066051928",
"telephone_number": "203-367-4571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MA",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-06",
"last_updated": "2026-01-15",
"certification_date": "2026-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "063971",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "15467",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.