Healthcare Provider Details

I. General information

NPI: 1427507425
Provider Name (Legal Business Name): CLAUDETTE ROBERGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2016
Last Update Date: 10/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 THOMPSON RD
EAST WINDSOR CT
06088-9626
US

IV. Provider business mailing address

6 THOMPSON RD
EAST WINDSOR CT
06088-9626
US

V. Phone/Fax

Practice location:
  • Phone: 860-623-3000
  • Fax: 860-623-3001
Mailing address:
  • Phone: 860-623-3000
  • Fax: 860-623-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0006427
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH24234
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: