Individual
IVAN THOMAS JUBILEE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
537 CANAL ST, STAMFORD, CT 06902-5901
(203) 323-1293
Mailing address
121 TOWNE ST APT 204, STAMFORD, CT 06902-5936
(607) 207-8587
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PCT.0016766
CT
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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