Individual
DR. MARY ANTONETTE EVANGELISTA CORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2870
(203) 384-3000
Mailing address
380 MATHER ST APT 6414, HAMDEN, CT 06514-3199
(201) 365-8136
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0202217006
VA
183500000X
Pharmacist
Primary
28RI03890300
NJ
183500000X
Pharmacist
PTP.0000548
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202217006
VIRGINIA BOARD OF PHARMACY
VA
01
—
28RI03890300
NEW JERSEY BOARD OF PHARMACY
NJ
01
—
PTP.0000548
CONNECTICUT BOARD OF PHARMACY
CT
Enumeration date
09/11/2020
Last updated
09/11/2020
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