Healthcare Provider Details

I. General information

NPI: 1104312727
Provider Name (Legal Business Name): ENTELA E CURRI PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ENTELA ELMAZAJ

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N COLONY RD
WALLINGFORD CT
06492-3109
US

IV. Provider business mailing address

605 N COLONY RD
WALLINGFORD CT
06492-3109
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-3600
  • Fax:
Mailing address:
  • Phone: 203-265-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT0014455
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: