1487788196 NPI number — UNIVERSITY OF CONNECTICUT

Table of content: (NPI 1487788196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487788196 NPI number — UNIVERSITY OF CONNECTICUT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF CONNECTICUT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487788196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 GLENBROOK RD
Provider Second Line Business Mailing Address:
UNIT 4011
Provider Business Mailing Address City Name:
STORRS MANSFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06269-9099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-486-0736
Provider Business Mailing Address Fax Number:
860-486-0792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 GLENBROOK RD
Provider Second Line Business Practice Location Address:
UNIT 4011
Provider Business Practice Location Address City Name:
STORRS MANSFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06269-9099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-486-0736
Provider Business Practice Location Address Fax Number:
860-486-0792
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STONE
Authorized Official First Name:
ASHLEE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
860-486-0736

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 51 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2000270 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008064757 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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