Healthcare Provider Details

I. General information

NPI: 1891452025
Provider Name (Legal Business Name): THOMAS MICHAEL FLYNN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N COLONY RD
WALLINGFORD CT
06492-2471
US

IV. Provider business mailing address

100 WOODSIDE CT UNIT 7203
TRUMBULL CT
06611-4985
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-6972
  • Fax:
Mailing address:
  • Phone: 516-983-2597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015628
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: