Provider Demographics
NPI:1043538986
Name:TAJUDEEN, AMI H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMI
Middle Name:H
Last Name:TAJUDEEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AMI
Other - Middle Name:H
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1232 STORRS RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2232
Mailing Address - Country:US
Mailing Address - Phone:860-429-9365
Mailing Address - Fax:860-429-0043
Practice Address - Street 1:1232 STORRS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06268-2232
Practice Address - Country:US
Practice Address - Phone:860-429-9365
Practice Address - Fax:860-429-0043
Is Sole Proprietor?:No
Enumeration Date:2010-05-16
Last Update Date:2010-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02836900183500000X
CTPCT.0010718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist