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General NPI Number Information
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NPI Number | 1457651119
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Entity Type | Individual
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Provider Name | PHYLLIS RUTH BLAUVELT RPH
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Gender | Female
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 80 SEYMOUR ST
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City | HARTFORD
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State | CT
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Zip | 06102-8000
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Country | US
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Telephone | 860-972-2961
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Fax |
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Provider Business Mailing Address
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Address Line | 80 SEYMOUR ST
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City | HARTFORD
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State | CT
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Zip | 06102-8000
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Country | US
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Telephone | 860-972-2961
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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.0009272
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH23749
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S011906
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License Number State | AZ
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