Healthcare Provider Details

I. General information

NPI: 1790849115
Provider Name (Legal Business Name): PHILIP MICHAEL HRITCKO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SALEM TPKE
NORWICH CT
06360-6459
US

IV. Provider business mailing address

89 HAREN DR
ROCKY HILL CT
06067-1063
US

V. Phone/Fax

Practice location:
  • Phone: 860-892-2711
  • Fax:
Mailing address:
  • Phone: 860-563-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number6756
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: