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General NPI Number Information
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NPI Number | 1396210688
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Entity Type | Individual
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Provider Name | REESHA BRODEUR WALDRON PHARMD, RPH
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Gender | Female
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 1600 BOSTON RD PHARMACY DEPT - REESHA WALDRON FLOATER RPH
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City | SPRINGFIELD
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State | MA
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Zip | 01129
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Country | US
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Telephone | 413-543-5428
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Fax | 413-543-0042
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Provider Business Mailing Address
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Address Line | 169 BEAUCHAMP TER
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City | CHICOPEE
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State | MA
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Zip | 01020-4101
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Country | US
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Telephone | 413-297-6157
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Fax | 413-543-0042
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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.0014610
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License Number State | CT
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