=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811016694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADINE DEBRA-ANN CROSS RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 WOODLAND AVE
-----------------------------------------------------
City | BLOOMFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-286-9177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 392 MILE HILL RD
-----------------------------------------------------
City | TOLLAND
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06084-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-870-4778
-----------------------------------------------------
Fax | 860-870-4778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 08481
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------