Provider Demographics
NPI:1316383052
Name:CANNATA, JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CANNATA
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 1:26 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1074
Mailing Address - Country:US
Mailing Address - Phone:860-721-0755
Mailing Address - Fax:
Practice Address - Street 1:80 CLARK DR
Practice Address - Street 2:SUITE B & C
Practice Address - City:EAST BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06023-1157
Practice Address - Country:US
Practice Address - Phone:866-632-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007424183500000X
VA0202209365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist