Healthcare Provider Details

I. General information

NPI: 1720807217
Provider Name (Legal Business Name): MARGARET MOKAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 QUALITY ST
TRUMBULL CT
06611-3143
US

IV. Provider business mailing address

43 SABRINA BROOKE LN
WESTFIELD MA
01085-4385
US

V. Phone/Fax

Practice location:
  • Phone: 203-261-3691
  • Fax:
Mailing address:
  • Phone: 413-579-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1000966
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: