Healthcare Provider Details

I. General information

NPI: 1154853166
Provider Name (Legal Business Name): JANNIE LAO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANNIE KO

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 RETREAT AVE
HARTFORD CT
06106-2527
US

IV. Provider business mailing address

79 RETREAT AVE
HARTFORD CT
06106-2527
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-4313
  • Fax:
Mailing address:
  • Phone: 860-972-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH237040
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0014668
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: