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General NPI Number Information
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NPI Number | 1184991218
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Entity Type | Individual
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Provider Name | BRIAN FOURNIER
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Gender | Male
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 633 WASHINGTON ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-2542
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Country | US
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Telephone | 860-346-7628
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Fax | 860-346-0090
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Provider Business Mailing Address
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Address Line | 7 RIVERCOVE DR
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City | CROMWELL
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State | CT
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Zip | 06416-1517
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Country | US
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Telephone |
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Fax |
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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 | PCT.0010432
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License Number State | CT
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