Individual
MYTHILI TARALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
54 BONNIE CT, BRISTOL, CT 06010-5994
(860) 583-7809
Mailing address
54 BONNIE CT, BRISTOL, CT 06010-5994
(860) 583-7809
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11465
CT
Other
Enumeration date
12/19/2017
Last updated
12/19/2017
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