Healthcare Provider Details

I. General information

NPI: 1811698541
Provider Name (Legal Business Name): KATHLEEN KIMBERLY-ADAMS BRUNAULT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN KIMBERLY ADAMS

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 MONTAUK AVE
NEW LONDON CT
06320-4769
US

IV. Provider business mailing address

69 N EAGLEVILLE RD UNIT 3092
STORRS CT
06269-3092
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-0711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPCT0013300
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: