=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093844284
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNDA LEE LORENZO RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 03/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2286 BERLIN TURNPIKE
-----------------------------------------------------
City | NEWINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06111-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-343-5220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CLUBHOUSE DRIVE
-----------------------------------------------------
City | CROMWELL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06416-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-559-3070
-----------------------------------------------------
Fax | 860-632-3127
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | CT5527
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------