Provider Demographics
NPI:1164832135
Name:PATTON, JEAN VAIDA (RPH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:VAIDA
Last Name:PATTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COONEY RD
Mailing Address - Street 2:
Mailing Address - City:POMFRET CTR
Mailing Address - State:CT
Mailing Address - Zip Code:06259-2232
Mailing Address - Country:US
Mailing Address - Phone:860-774-8026
Mailing Address - Fax:
Practice Address - Street 1:108 COONEY RD
Practice Address - Street 2:
Practice Address - City:POMFRET CTR
Practice Address - State:CT
Practice Address - Zip Code:06259-2232
Practice Address - Country:US
Practice Address - Phone:860-774-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010025183500000X
MAPH18141183500000X
NH2272183500000X
RIRPH04566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist