Healthcare Provider Details

I. General information

NPI: 1437708708
Provider Name (Legal Business Name): CLEAN RXEACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 POST RD STE 4
FAIRFIELD CT
06824-5916
US

IV. Provider business mailing address

340 PRAYER SPRING RD
STRATFORD CT
06614-1322
US

V. Phone/Fax

Practice location:
  • Phone: 203-292-0764
  • Fax: 214-440-1671
Mailing address:
  • Phone: 214-991-6411
  • Fax: 214-440-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AIKATERINI FINETI
Title or Position: OWNER
Credential:
Phone: 203-292-0764