Healthcare Provider Details

I. General information

NPI: 1801375068
Provider Name (Legal Business Name): MARIJANA TODOSIEV PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STATE ROUTE 39
NEW FAIRFIELD CT
06812-4044
US

IV. Provider business mailing address

25 STATE ROUTE 39
NEW FAIRFIELD CT
06812-4044
US

V. Phone/Fax

Practice location:
  • Phone: 203-312-9818
  • Fax: 844-411-6588
Mailing address:
  • Phone: 203-312-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0012102
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: