Individual
ASA TSOI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2175 DIXWELL AVE, HAMDEN, CT 06514-2405
(203) 288-3895
Mailing address
2175 DIXWELL AVE, HAMDEN, CT 06514-2405
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0013911
CT
Other
Enumeration date
09/26/2016
Last updated
09/26/2016
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