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General NPI Number Information
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NPI Number | 1346520012
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Entity Type | Individual
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Provider Name | NICOLAS RODER-HANNA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 130 S MAIN ST STE 1B
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City | THOMASTON
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State | CT
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Zip | 06787-1741
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Country | US
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Telephone | 860-484-4245
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Fax |
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Provider Business Mailing Address
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Address Line | 14 VALLEYVIEW LN
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City | COLLINSVILLE
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State | CT
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Zip | 06019-3424
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Country | US
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Telephone | 860-614-6563
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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.0012101
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License Number State | CT
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