Healthcare Provider Details

I. General information

NPI: 1326317728
Provider Name (Legal Business Name): ATULA VIMAL VACHHANI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 BERLIN TPKE T-1802
NEWINGTON CT
06111-5101
US

IV. Provider business mailing address

3265 BERLIN TPKE T-1802
NEWINGTON CT
06111-5101
US

V. Phone/Fax

Practice location:
  • Phone: 860-616-0023
  • Fax: 860-616-2487
Mailing address:
  • Phone: 860-616-0023
  • Fax: 860-616-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0011309
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: