Provider Demographics
NPI:1093087264
Name:AUSTIN, DENIS PATRICK (RPH)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:PATRICK
Last Name:AUSTIN
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 1:21 BROAD ST
Mailing Address - Street 2:T1544
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2309
Mailing Address - Country:US
Mailing Address - Phone:203-388-0038
Mailing Address - Fax:
Practice Address - Street 1:21 BROAD ST
Practice Address - Street 2:T1544
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2309
Practice Address - Country:US
Practice Address - Phone:203-388-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246840Medicaid