Provider Demographics
NPI:1174958953
Name:MANCHESTER RX LLC
Entity type:Organization
Organization Name:MANCHESTER RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SATYANARAYANA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:ANNAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-649-1025
Mailing Address - Street 1:348 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4123
Mailing Address - Country:US
Mailing Address - Phone:860-649-1025
Mailing Address - Fax:860-649-0457
Practice Address - Street 1:348 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4123
Practice Address - Country:US
Practice Address - Phone:860-649-1025
Practice Address - Fax:860-649-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY00012903336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142648OtherPK
NY008047311Medicaid
NY0723381OtherNCPDP
6932760001Medicare NSC