Provider Demographics
NPI:1366858359
Name:MAROTTA, KRYSTEN N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTEN
Middle Name:N
Last Name:MAROTTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 VERA ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1948
Mailing Address - Country:US
Mailing Address - Phone:609-668-5018
Mailing Address - Fax:
Practice Address - Street 1:1290 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-560-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist