Provider Demographics
NPI:1336468388
Name:FIDLER, STANLEY (RPH)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:FIDLER
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 1:54 SUNNYCREST RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4433
Mailing Address - Country:US
Mailing Address - Phone:203-362-8810
Mailing Address - Fax:203-452-8282
Practice Address - Street 1:54 SUNNYCREST RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4433
Practice Address - Country:US
Practice Address - Phone:203-362-8810
Practice Address - Fax:203-452-8282
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025486-1183500000X
CT007610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist