Healthcare Provider Details

I. General information

NPI: 1821508664
Provider Name (Legal Business Name): THEODORE MICHAEL WOJCIK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 FOXON RD
NORTH BRANFORD CT
06471-1289
US

IV. Provider business mailing address

1289 FOXON RD
NORTH BRANFORD CT
06471-1289
US

V. Phone/Fax

Practice location:
  • Phone: 203-484-9681
  • Fax: 855-768-0814
Mailing address:
  • Phone: 203-484-9681
  • Fax: 855-768-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0006647
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: