MEDICARE: XHENSILA ALICKOLLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13452	CT

General Provider Information

NPI Number	:	1043668809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XHENSILA ALICKOLLI

Provider Business Mailing Address
First Line	:	12 OAKCREST CIR
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-1868
Country	:	US
Telephone Number	:	203-233-7437
Fax Number	:

Provider Business Practice Location Address
First Line	:	1279 W MAIN ST
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-3101
Country	:	US
Telephone Number	:	203-755-5490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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Directions to “ XHENSILA ALICKOLLI ” Practice Location

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