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NPI Code Detail

MEDICARE: MR. RONALD JOEL WISSUCHEK PHARMACISTS

MEDICARE: MR. RONALD JOEL WISSUCHEK PHARMACISTS
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
11835G0303XGeriatric Pharmacist0006212CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10006212OTHERCTCONNECTICUT STATE PHARMACIST LIC

General Provider Information

NPI Number : 1114226248
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD JOEL WISSUCHEK PHARMACISTS
Provider Business Mailing Address
First Line : 1291 ALBANY AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06112-2198
Country : US
Telephone Number : 860-560-1881
Fax Number : 860-560-0614
Provider Business Practice Location Address
First Line : 1291 ALBANY AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06112-2198
Country : US
Telephone Number : 860-560-1881
Fax Number : 860-560-0614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2011
Last Update Date : 03/15/2011

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