Provider Demographics
NPI:1356834717
Name:TORDONATO, GINO JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:GINO
Middle Name:
Last Name:TORDONATO
Suffix:JR
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 1:1380 BERLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1093
Mailing Address - Country:US
Mailing Address - Phone:860-956-3740
Mailing Address - Fax:
Practice Address - Street 1:1380 BERLIN TPKE
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1093
Practice Address - Country:US
Practice Address - Phone:860-956-3740
Practice Address - Fax:844-411-6427
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT08568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist