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General NPI Number Information
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NPI Number | 1730779935
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Entity Type | Individual
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Provider Name | ROBERT TANGUAY CPHT
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Gender | Male
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 675 N MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06704-3508
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Country | US
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Telephone | 203-753-5158
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Fax | 203-597-0625
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Provider Business Mailing Address
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Address Line | 675 N MAIN ST
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City | WATERBURY
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State | CT
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Zip | 06704-3508
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Country | US
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Telephone | 203-753-5158
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Fax | 203-597-0625
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PTN.0001065
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License Number State | CT
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