Provider Demographics
NPI:1093800484
Name:VENDETTI, DANIEL ANTHONY
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANTHONY
Last Name:VENDETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROXBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1458
Mailing Address - Country:US
Mailing Address - Phone:860-621-7808
Mailing Address - Fax:
Practice Address - Street 1:2 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4112
Practice Address - Country:US
Practice Address - Phone:203-723-1376
Practice Address - Fax:203-720-1626
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist