Healthcare Provider Details

I. General information

NPI: 1386197887
Provider Name (Legal Business Name): JESSICA ANNE WIERZBICKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 BOSTON POST RD
MILFORD CT
06460-2704
US

IV. Provider business mailing address

139 OCEAN AVE
WEST HAVEN CT
06516-7014
US

V. Phone/Fax

Practice location:
  • Phone: 203-877-6774
  • Fax:
Mailing address:
  • Phone: 203-645-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0013802
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: