Healthcare Provider Details

I. General information

NPI: 1457920100
Provider Name (Legal Business Name): GWENDOLYN PATRICIA MAUCERI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GWENDOLYN PATRICIA BRONNES PHARMD

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 MAIN ST
SPRINGFIELD MA
01103-2114
US

IV. Provider business mailing address

44 MOUNTAIN RD
TARIFFVILLE CT
06081-9617
US

V. Phone/Fax

Practice location:
  • Phone: 413-693-1005
  • Fax:
Mailing address:
  • Phone: 978-424-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH240861
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015550
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: