Provider Demographics
NPI:1114202116
Name:LAVOURA, MANUEL PINHO (RPH)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:PINHO
Last Name:LAVOURA
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 1:303 STONEFENCE RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1553
Mailing Address - Country:US
Mailing Address - Phone:203-720-1858
Mailing Address - Fax:
Practice Address - Street 1:779 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1615
Practice Address - Country:US
Practice Address - Phone:203-822-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT-08426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist