Provider Demographics
NPI:1164908398
Name:GAZETOS, DREW
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:GAZETOS
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 1:508 MONROE TPKE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2309
Mailing Address - Country:US
Mailing Address - Phone:203-268-6315
Mailing Address - Fax:
Practice Address - Street 1:508 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2309
Practice Address - Country:US
Practice Address - Phone:203-268-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist