Healthcare Provider Details

I. General information

NPI: 1851743959
Provider Name (Legal Business Name): ROGER BEAUDOIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MAIN ST
CHESHIRE CT
06410-2406
US

IV. Provider business mailing address

1382 WOLCOTT RD
WOLCOTT CT
06716-1502
US

V. Phone/Fax

Practice location:
  • Phone: 203-272-3543
  • Fax:
Mailing address:
  • Phone: 860-921-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0013754
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: