Healthcare Provider Details

I. General information

NPI: 1114311891
Provider Name (Legal Business Name): CAROLYN GELINEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WESTFIELD ST
WEST SPRINGFIELD MA
01089-2550
US

IV. Provider business mailing address

15 KATIE WAY
SPRINGFIELD MA
01128-1045
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-6523
  • Fax:
Mailing address:
  • Phone: 781-697-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25103
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: