Healthcare Provider Details

I. General information

NPI: 1861841546
Provider Name (Legal Business Name): KARI ANN GUERETTE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 MAIN ST
SOMERS CT
06071-2102
US

IV. Provider business mailing address

PO BOX 397 629 MAIN STREET
SOMERS CT
06071-0397
US

V. Phone/Fax

Practice location:
  • Phone: 860-749-3433
  • Fax: 860-749-0731
Mailing address:
  • Phone: 860-749-3433
  • Fax: 860-749-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0007550
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH21612
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: