Healthcare Provider Details

I. General information

NPI: 1528556271
Provider Name (Legal Business Name): KATRINA SKROUPA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BERLIN RD
CROMWELL CT
06416-1021
US

IV. Provider business mailing address

161 BERLIN RD
CROMWELL CT
06416-1021
US

V. Phone/Fax

Practice location:
  • Phone: 860-635-1507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0011682
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: