Healthcare Provider Details

I. General information

NPI: 1447418421
Provider Name (Legal Business Name): NATHAN J LOEFFLER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIN ST
WINDSOR LOCKS CT
06096-1913
US

IV. Provider business mailing address

38 WARANOKE RD
MANCHESTER CT
06040-4527
US

V. Phone/Fax

Practice location:
  • Phone: 860-623-2407
  • Fax:
Mailing address:
  • Phone: 860-649-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6557
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24226
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number114534-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: