Healthcare Provider Details

I. General information

NPI: 1851919443
Provider Name (Legal Business Name): RACHAEL LAUREN GERSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

111 PARK ST
NEW HAVEN CT
06511-5412
US

V. Phone/Fax

Practice location:
  • Phone: 888-461-0106
  • Fax:
Mailing address:
  • Phone: 570-606-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015189
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: