Healthcare Provider Details

I. General information

NPI: 1609917814
Provider Name (Legal Business Name): TIMOTHY DANIEL MURAWSKI R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MAIN ST
TERRYVILLE CT
06786-5910
US

IV. Provider business mailing address

143 SCHROBACK RD
PLYMOUTH CT
06782-2003
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-5158
  • Fax: 860-589-8699
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5730
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17648
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: