Provider Demographics
NPI:1194185116
Name:POCHAL, BRIAN MARK
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MARK
Last Name:POCHAL
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 1:15 CHESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1730
Mailing Address - Country:US
Mailing Address - Phone:860-739-0276
Mailing Address - Fax:860-739-0329
Practice Address - Street 1:15 CHESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1730
Practice Address - Country:US
Practice Address - Phone:860-739-0276
Practice Address - Fax:860-739-0329
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist