Provider Demographics
NPI:1275881542
Name:DEGROFF, TODD STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:STEPHEN
Last Name:DEGROFF
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 1:220 CRATER LN
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2724
Mailing Address - Country:US
Mailing Address - Phone:860-202-9213
Mailing Address - Fax:
Practice Address - Street 1:543 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3915
Practice Address - Country:US
Practice Address - Phone:860-225-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist