MEDICARE: LAUREN MASTRO

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	13666	CT

General Provider Information

NPI Number	:	1801369616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MASTRO

Provider Business Mailing Address
First Line	:	104 THREE MILE RD
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-3851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 FARMINGTON AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2618
Country	:	US
Telephone Number	:	860-521-9877
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	11/18/2020

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Directions to “ LAUREN MASTRO ” Practice Location

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