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General NPI Number Information
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NPI Number | 1518493790
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Entity Type | Individual
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Provider Name | ANDREA IDUSUYI PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 05/07/2017
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Last Update Date | 05/07/2017
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Provider Practice Location Address
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Address Line | 286 BROAD ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4049
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Country | US
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Telephone | 860-647-0325
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Fax |
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Provider Business Mailing Address
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Address Line | 20 FRONT ST
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City | HARTFORD
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State | CT
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Zip | 06103-2845
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Country | US
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Telephone | 781-244-3989
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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 | 0013351
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License Number State | CT
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