Provider Demographics
NPI:1285217703
Name:WRONOWSKI, JENNIFER MARIA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIA
Last Name:WRONOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4471
Mailing Address - Country:US
Mailing Address - Phone:959-666-0390
Mailing Address - Fax:203-259-1869
Practice Address - Street 1:1619 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5910
Practice Address - Country:US
Practice Address - Phone:203-259-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPTN.0010050183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician