MEDICARE: MRS. LORI CHUCKTA RPH

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	6397	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	413949	OTHER	CT	NABP

General Provider Information

NPI Number	:	1841602059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI CHUCKTA RPH

Provider Business Mailing Address
First Line	:	37 NEW HAVEN RD
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-3460
Country	:	US
Telephone Number	:	203-888-0073
Fax Number	:	203-888-2932

Provider Business Practice Location Address
First Line	:	37 NEW HAVEN RD
Second Line	:
City	:	SEYMOUR
State	:	CT
Zip	:	06483-3460
Country	:	US
Telephone Number	:	203-888-0073
Fax Number	:	203-888-2932

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

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	05/21/2014

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