Healthcare Provider Details

I. General information

NPI: 1306166491
Provider Name (Legal Business Name): SONALI CHAKRABORTI-COSTA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SADDLE RD
NORWALK CT
06851-3207
US

IV. Provider business mailing address

31 SADDLE RD
NORWALK CT
06851-3207
US

V. Phone/Fax

Practice location:
  • Phone: 516-662-9895
  • Fax:
Mailing address:
  • Phone: 516-662-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053339
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT0009792
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: