Healthcare Provider Details

I. General information

NPI: 1114226248
Provider Name (Legal Business Name): RONALD JOEL WISSUCHEK PHARMACISTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 ALBANY AVE
HARTFORD CT
06112-2198
US

IV. Provider business mailing address

1291 ALBANY AVE
HARTFORD CT
06112-2198
US

V. Phone/Fax

Practice location:
  • Phone: 860-560-1881
  • Fax: 860-560-0614
Mailing address:
  • Phone: 860-560-1881
  • Fax: 860-560-0614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number0006212
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: