Individual
TAT NG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 REIDVILLE DR, WATERBURY, CT 06705-2660
(203) 755-5814
Mailing address
PO BOX 1156, MIDDLEBURY, CT 06762-1156
(203) 278-0014
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6563
CT
Other
Enumeration date
06/05/2017
Last updated
06/05/2017
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