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General NPI Number Information
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NPI Number | 1629665492
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Entity Type | Individual
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Provider Name | MARY ELSENBOSS TYRRELL BS PHARM, PD
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Gender | Female
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 2 MAIN ST N
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City | WOODBURY
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State | CT
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Zip | 06798-2950
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Country | US
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Telephone | 203-263-2595
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Fax | 203-263-7244
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Provider Business Mailing Address
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Address Line | PO BOX 363
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City | WOODBURY
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State | CT
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Zip | 06798-0363
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Country | US
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Telephone | 203-263-2595
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Fax | 203-263-7244
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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.0005949
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License Number State | CT
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