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Individual

CASEY NOWOBILSKI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RPH

Contact information

Practice address
153 HAZARD AVE, ENFIELD, CT 06082-4592
(860) 253-2605
(860) 749-7134
Mailing address
19 HUNTING RIDGE DR, SIMSBURY, CT 06070
(860) 253-2605
(860) 749-7134

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
051-036143
IL
183500000X
Pharmacist
Primary
09123
CT
183500000X
Pharmacist
PH234374
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
09123
CT REG
CT
Enumeration date
02/05/2016
Last updated
02/05/2016
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