Healthcare Provider Details

I. General information

NPI: 1528043874
Provider Name (Legal Business Name): ROBERT JOSEPH JANSING R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 02/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 KENNEDY RD
WINDSOR CT
06095-1308
US

IV. Provider business mailing address

260 WILLINGTON HILL RD
WILLINGTON CT
06279-1922
US

V. Phone/Fax

Practice location:
  • Phone: 860-907-3069
  • Fax: 860-907-3069
Mailing address:
  • Phone: 860-429-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8587
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: