MEDICARE: MICHAEL G DEOTTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PCT.0014915	CT

General Provider Information

NPI Number	:	1255988523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL G DEOTTE

Provider Business Mailing Address
First Line	:	41 MAPLE AVE
Second Line	:
City	:	DERBY
State	:	CT
Zip	:	06418-1328
Country	:	US
Telephone Number	:	508-353-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 PERSHING DR
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-2214
Country	:	US
Telephone Number	:	203-735-7837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	08/21/2019

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Directions to “ MICHAEL G DEOTTE ” Practice Location

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