Provider Demographics
NPI:1083997852
Name:DADDARIO, FREDERICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:DADDARIO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WASHINGTON ST
Mailing Address - Street 2:APT 18
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6066
Mailing Address - Country:US
Mailing Address - Phone:860-447-0488
Mailing Address - Fax:
Practice Address - Street 1:698 BANK ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5040
Practice Address - Country:US
Practice Address - Phone:860-440-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00072271835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist