MEDICARE: DR. NICOLAS RODER-HANNA PHARMD

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	PCT.0012101	CT

General Provider Information

NPI Number	:	1346520012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLAS RODER-HANNA PHARMD

Provider Business Mailing Address
First Line	:	14 VALLEYVIEW LN
Second Line	:
City	:	COLLINSVILLE
State	:	CT
Zip	:	06019-3424
Country	:	US
Telephone Number	:	860-614-6563
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 S MAIN ST STE 1B
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1741
Country	:	US
Telephone Number	:	860-484-4245
Fax Number	:

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

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	06/29/2021

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