Healthcare Provider Details

I. General information

NPI: 1063170322
Provider Name (Legal Business Name): KATHRYN SACRO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN STECKOWYCH PHARMD

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PARK ST
NEW HAVEN CT
06511-5474
US

IV. Provider business mailing address

281 EASTBURY HILL RD
GLASTONBURY CT
06033-3940
US

V. Phone/Fax

Practice location:
  • Phone: 475-246-9956
  • Fax:
Mailing address:
  • Phone: 603-498-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPCT.0013683
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: