Healthcare Provider Details

I. General information

NPI: 1710607254
Provider Name (Legal Business Name): JOHN DONALD GUMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MONROE TPKE
MONROE CT
06468-2246
US

IV. Provider business mailing address

618A ERIE LN
STRATFORD CT
06614-8229
US

V. Phone/Fax

Practice location:
  • Phone: 203-268-1216
  • Fax:
Mailing address:
  • Phone: 203-400-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015973
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: