Healthcare Provider Details

I. General information

NPI: 1285912808
Provider Name (Legal Business Name): JENNIFER MCCUE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2011
Last Update Date: 07/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ANNIE GEORGE DR BLDG 1
MASHANTUCKET CT
06338-3801
US

IV. Provider business mailing address

1 ANNIE GEORGE DR BLDG 1
MASHANTUCKET CT
06338-3801
US

V. Phone/Fax

Practice location:
  • Phone: 860-396-6438
  • Fax:
Mailing address:
  • Phone: 860-396-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0007203
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: