Healthcare Provider Details

I. General information

NPI: 1740661990
Provider Name (Legal Business Name): ROMAN ZAETS I PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2015
Last Update Date: 06/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CHURCH ST
NEW HAVEN CT
06510-3304
US

IV. Provider business mailing address

66 CHURCH ST
NEW HAVEN CT
06510-3304
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7248
  • Fax: 203-777-2722
Mailing address:
  • Phone: 203-777-7248
  • Fax: 203-777-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0013081
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: