| NPI | 1164835153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SADAF WAQAR Owner 860-674-9900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 53002) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2024-03-14 |