MY FAIR HAVEN PHARMACY LLC (NPI# 1568839876) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568839876 |
| Entity Type | Organization |
| Organization Name | MY FAIR HAVEN PHARMACY LLC |
| Other Organization Name | FAIR HAVEN PHARMACY |
| Practice Address |
72 Grand Ave New Haven CT 06513 |
| Practice Telephone | 2034983479 |
| Practice Fax Number | 2034988000 |
| Mailing Telephone | 2034983479 |
| Mailing Fax Number | 2034988000 |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2016-04-01 |
| Authorized Official Name | MANTHENA V VARMA (MEMBER) |
| Authorized Official Telephone | 2034983479 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PCY.0002315 | CT | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | MEDICAID DME | 008064135 | 01 |
| CT | 008061384 | 05 |
| Other Name | Type Code |
|---|---|
| Fair Haven Pharmacy | Doing Business As Name - Organization |
| Street Address |
72 GRAND AVE |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366906141 | Edward Rivera | Case Manager/Care Coordinator | 458 Grand Ave., Suite 103, New Haven, CT 06513 | 2019-01-25 |
| 1134698442 | Village of Angels Home Health Care LLC | Respite Care | 470 James Street, Suite 007, New Haven, CT 06513 | 2018-11-15 |
| 1609358068 | Sarah Khalil | Pharmacist | 745 Foxon Road, East Haven, CT 06513 | 2018-09-02 |
| 1912358375 | Domanice Poindexter | Nurse Practitioner | Caremore Health, 444 Foxon Rd, East Haven, CT 06513 | 2016-06-28 |
| 1871979567 | Sankofa Counseling LLC | Community/Behavioral Health | 64 Thompson St Ste A101, East Haven, CT 06513 | 2015-08-04 |
| 1578967287 | Curtis Stewart | Pharmacy Technician | 661 Thompson Street, East Haven, CT 06513 | 2014-10-09 |
| 1548686322 | Davis Group LLC | Social Worker | 30 Grand Ave, New Haven, CT 06513 | 2014-03-17 |
| 1124459615 | James Lucas IIi | Dietitian, Registered | 167 Old Foxon Road, Unit 30b, New Haven, CT 06513 | 2013-12-09 |
| 1609206135 | Spretha Kadavath | Dentist | 50 Grand Ave, New Haven, CT 06513 | 2013-11-19 |
| 1992134878 | Joon Lee | Occupational Therapist | 918 Quinnipiac Ave #2, New Haven, CT 06513 | 2013-11-01 |
| Find all providers in zip 06513 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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|---|---|---|---|---|
| 1497277339 | New Haven Health-aid Pharmacy LLC | Pharmacy | 307 5th St, New Haven, WV 25265 | 2017-07-12 |
| 1619338753 | Cornerstone Pharmacy Inc | Pharmacy | 399 Whalley Ave, New Haven, CT 06511 | 2016-03-17 |
| 1689964272 | Hancock Pharmacy At Long Wharf Inc | Pharmacy | 1 Long Wharf Dr Ste 116, New Haven, CT 06511-5991 | 2011-04-15 |
| 1578666202 | Hook Superx LLC | Pharmacy | 115 State Road 930 E, New Haven, IN 46774-1359 | 2006-09-07 |
| 1962982652 | New Haven Pharmacy LLC | Pharmacy | 307 5th St, New Haven, WV 25265-4100 | 2018-08-21 |
| 1295032449 | Downriver Community Services Inc | Pharmacy | 58144 Gratiot Ave, New Haven, MI 48048 | 2011-02-24 |
| 1629396403 | Hancock Pharmacy Vii LLC | Pharmacy | 306 Grand Ave, New Haven, CT 06513-3730 | 2010-05-04 |
| 1518172451 | Cornell Scott-hill Health Corporation | Pharmacy | 428 Columbus Ave, New Haven, CT 06519 | 2007-05-14 |
| 1750423471 | Cornell Scott Hill Health Corporation | Pharmacy | 428 Columbus Ave, New Haven, CT 06519-1233 | 2007-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952918666 | Orangerx Pharmacy Inc | Pharmacy | 240 Indian River Rd Unit F, Orange, CT 06477-3649 | 2020-09-26 |
| 1568072627 | Corporate Pharmacy Corp | Pharmacy | 4 Corporate Dr Ste 198, Shelton, CT 06484-6240 | 2020-08-04 |
| 1669094439 | Cx Pharmacy Corp | Pharmacy | 110 Commerce Dr Ste 250, Shelton, CT 06484-6259 | 2020-05-14 |
| 1932746591 | Nutmeg Pharmacy Moodus LLC | Pharmacy | 38 William F Palmer Rd, Moodus, CT 06469-1131 | 2019-12-03 |
| 1811531544 | Medical Center Pharmacy and Home Care Center, Inc. | Pharmacy | 600 Derby Avenue, West Haven, CT 06516 | 2019-11-06 |
| 1649814633 | Saint Francis Hospital and Medical Center | Pharmacy | 131 Coventry St Ste 2, Hartford, CT 06112-1548 | 2019-11-01 |
| 1336782804 | Royal Pharmacy LLC | Pharmacy | 1420 Meriden Rd, Waterbury, CT 06705-3632 | 2019-10-28 |
| 1760032627 | Westport Apothecary LLC | Pharmacy | 125 Post Rd E, Westport, CT 06880-3410 | 2019-09-12 |
| 1871146803 | Care Plus Rx Solutions LLC | Pharmacy | 250 Indian River Rd, Orange, CT 06477-3627 | 2019-07-18 |
| 1295209773 | Black Rock Pharmacy LLC | Pharmacy | 1838 Black Rock Tpke, Fairfield, CT 06825-3500 | 2019-01-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.