Healthcare Provider Details

I. General information

NPI: 1851804108
Provider Name (Legal Business Name): LUCYNA KUDRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3164 BERLIN TPKE
NEWINGTON CT
06111-4627
US

IV. Provider business mailing address

3164 BERLIN TPKE
NEWINGTON CT
06111-4627
US

V. Phone/Fax

Practice location:
  • Phone: 860-667-0152
  • Fax: 860-667-4844
Mailing address:
  • Phone: 860-667-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0009111
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: