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MAIN STREET PHARMACY 3 LLC
NPI 1316249352
Pharmacy in Bridgeport, CT

Active since November 24, 2010CLIA 07D2119191 · Waiver
2117 BOSTON AVE, BRIDGEPORT, CT 06610(203) 212-3800(203) 212-3802 Get Directions Write a Review

NPPES record last updated: March 9, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Main Street Pharmacy 3 Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAIN STREET PHARMACY 3 LLC (NPI 1316249352) is a healthcare organization registered as a pharmacy in Bridgeport, Connecticut and active in the NPI registry since November 2010. The organization holds a CLIA Waiver certificate valid through September 20, 2026 and lists Jean K. Jacob, Owner, as its authorized official.

NPPES Registry Identity

NPI1316249352
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameMAIN STREET PHARMACY 3 LLC
Location Address2117 BOSTON AVEBridgeport, CT 06610-3030
Mailing Address2117 Boston AveBridgeport, CT 06610-3030 · (203) 212-3800 · Fax (203) 212-3802
Phone(203) 212-3800
Fax(203) 212-3802
Organization SubpartNo
Authorized OfficialJean K. JacobOwner · 20321238001
Enumeration DateNovember 24, 2010
Last NPPES UpdateMarch 9, 2015
✔ NPI 1316249352 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in CT · PCY2190
Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedDurable Medical Equipment & Medical Supplies · Parenteral & Enteral NutritionTaxonomy 332BP3500X
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
Also ListedPharmacy · Compounding PharmacyTaxonomy 3336C0004X
Also ListedPharmacy · Specialty PharmacyTaxonomy 3336S0011X
2117 BOSTON AVE, Bridgeport, CT 06610
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Other Identifiers 3

Medicare PIND300189345CT
Medicaid008032995CT
Medicare NSC7279170001CT

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 07D2119191

Main Street Pharmacy · Bridgeport, CT
Active · expires Sep 20, 2026
CLIA Number07D2119191
Laboratory TypePharmacy
Certificate Effective DateSeptember 21, 2024
Certificate Expiration DateSeptember 20, 2026
Laboratory DirectorJean K. Jacob
Laboratory Phone(203) 212-3800
Laboratory LocationMain Street Pharmacy2117 Boston Ave, Bridgeport, CT 06610
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS 25

Medicare supplier enrollment and the product categories Main Street Pharmacy 3 LLC carries, from the Medicare DMEPOS supplier directory.

Main Street Pharmacy 3 LLC

DMEPOS supplier · Bridgeport, CT
⋮

Does not accept Medicare assignment

Main Street Pharmacy 3 LLC has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20456987
Medicare Participant SinceJanuary 1, 2018
Supplier Location2117 Boston AveBridgeport, CT 06610
Phone(203) 212-3800
Supplier Specialties
Pharmacy

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MELISSA BOUDREAU
Pharmacist
2117 BOSTON AVE
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 212-3800
NEHAH LLC
Homemaker
2117 BOSTON AVE
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 590-1947
DR. JEAN K JACOB PHARM.D.
Pharmacist
2117 BOSTON AVE
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 493-4251
MAIN STREET PHARMACY 3 LLC
Pharmacy (Long Term Care Pharmacy)
2117 BOSTON AVE
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 212-3800
DR. OLUSEGUN JOSHUA AWODELE PHARM. D
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
2117 BOSTON AVE
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 212-3800
DR. ZENUB PARUPIA PHARM. D.
Pharmacist
2117 BOSTON AVE
BRIDGEPORT, CT 06610
Greater Bridgeport Planning Region (203) 212-3800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Main Street Pharmacy 3 LLC's NPI number?

The NPI number for Main Street Pharmacy 3 LLC is 1316249352. It was assigned to this organization in the NPPES registry on November 24, 2010.

Where is Main Street Pharmacy 3 LLC located?

Main Street Pharmacy 3 LLC is located at 2117 Boston Ave, Bridgeport, CT 06610. The listed phone number is (203) 212-3800.

What is Main Street Pharmacy 3 LLC's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Does Main Street Pharmacy 3 LLC accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Main Street Pharmacy 3 LLC does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Main Street Pharmacy 3 LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 07D2119191) is associated with this NPI, valid through September 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Main Street Pharmacy 3 LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 47 other insurers list Main Street Pharmacy 3 LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Main Street Pharmacy 3 LLC was last updated on March 9, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.