Individual
DANIEL TAVARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
26 FALLS RD, MOODUS, CT 06469-1262
(860) 367-4773
Mailing address
12 KEYBOARD LN, IVORYTON, CT 06442-1265
(860) 367-4773
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PCT.0012072
CT
Other
Enumeration date
06/18/2018
Last updated
01/27/2020
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