Healthcare Provider Details

I. General information

NPI: 1306356191
Provider Name (Legal Business Name): JANICE C FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 STONINGTON RD
MYSTIC CT
06355-2931
US

IV. Provider business mailing address

7 SOUND BREEZE AVE
GROTON CT
06340-8846
US

V. Phone/Fax

Practice location:
  • Phone: 860-536-5835
  • Fax: 860-536-5837
Mailing address:
  • Phone: 413-627-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH19257
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57124
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0006175
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: