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General NPI Number Information
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NPI Number | 1417671348
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Entity Type | Individual
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Provider Name | SHEA ROSE DORSEY
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Gender | Female
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 734 BRIDGEPORT AVE
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City | MILFORD
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State | CT
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Zip | 06460-3169
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Country | US
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Telephone | 203-877-8127
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Fax |
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Provider Business Mailing Address
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Address Line | 52 HARMONY LN
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City | MONROE
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State | CT
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Zip | 06468-1138
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Country | US
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Telephone | 203-522-0725
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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 | 0015588
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License Number State | CT
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