Individual
RICKY PHONGSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 ROUTE 32, UNCASVILLE, CT 06382-2104
(860) 848-7979
Mailing address
119 S MAIN ST, COLCHESTER, CT 06415-1456
(860) 537-0711
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PCT.0014070
CT
Other
Enumeration date
08/07/2017
Last updated
11/14/2021
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