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General NPI Number Information
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NPI Number | 1104100494
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Entity Type | Individual
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Provider Name | RONALD JOSEPH MALYSKA RPH
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Gender | Male
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 1030 BARNUM AVE
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City | STRATFORD
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State | CT
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Zip | 06614-4985
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Country | US
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Telephone | 230-378-9394
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Fax | 230-385-8651
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Provider Business Mailing Address
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Address Line | 1030 BARNUM AVE.
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City | STARTFORD
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State | CT
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Zip | 06468
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Country | US
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Telephone | 230-378-9394
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Fax | 230-385-8651
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5711
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License Number State | CT
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