Provider Demographics
NPI:1144757543
Name:SCARAMUZZI, DAVID KENNETH
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KENNETH
Last Name:SCARAMUZZI
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 1:355 ROBIN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-2141
Mailing Address - Country:US
Mailing Address - Phone:401-644-7926
Mailing Address - Fax:860-739-9844
Practice Address - Street 1:248 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1264
Practice Address - Country:US
Practice Address - Phone:860-739-5957
Practice Address - Fax:860-739-9844
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist