Healthcare Provider Details

I. General information

NPI: 1316383052
Provider Name (Legal Business Name): JOSEPH CANNATA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CLARK DR SUITE B & C
EAST BERLIN CT
06023-1157
US

IV. Provider business mailing address

26 BOULDER DR
ROCKY HILL CT
06067-1074
US

V. Phone/Fax

Practice location:
  • Phone: 866-632-1551
  • Fax:
Mailing address:
  • Phone: 860-721-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0007424
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209365
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: