Healthcare Provider Details

I. General information

NPI: 1457575573
Provider Name (Legal Business Name): MRS. JOAN F. MASTRANTUONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RT. 37
NEW FAIRFIELD CT
06812
US

IV. Provider business mailing address

184 OLD WOODBURY RD
SOUTHBURY CT
06488-1949
US

V. Phone/Fax

Practice location:
  • Phone: 203-746-2404
  • Fax:
Mailing address:
  • Phone: 203-264-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: