Provider Demographics
NPI:1306356191
Name:FLYNN, JANICE C
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:FLYNN
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 1:7 SOUND BREEZE AVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-8846
Mailing Address - Country:US
Mailing Address - Phone:413-627-7684
Mailing Address - Fax:
Practice Address - Street 1:79 STONINGTON RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2931
Practice Address - Country:US
Practice Address - Phone:860-536-5835
Practice Address - Fax:860-536-5837
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH19257183500000X
FLPS57124183500000X
CTPCT.0006175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist