Individual
TERESA REVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
100 DIVISION ST, ANSONIA, CT 06401-2147
(203) 732-3907
Mailing address
100 DIVISION ST, ANSONIA, CT 06401-2147
(203) 732-3907
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0012246
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PCT.0012246
DEPARTMENT OF CONSUMER AFFAIRS, CONNECTICUT
CT
Enumeration date
07/25/2018
Last updated
07/25/2018
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