Provider Demographics
NPI:1376883413
Name:LAGASSE, JEFFREY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LAGASSE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:LAGASSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:441 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-3119
Mailing Address - Country:US
Mailing Address - Phone:413-519-5080
Mailing Address - Fax:413-519-5080
Practice Address - Street 1:31 MOODY RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3101
Practice Address - Country:US
Practice Address - Phone:860-763-7020
Practice Address - Fax:860-763-7022
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21990183500000X
VA0202211988183500000X
ORRPH-0013511183500000X
NE14388183500000X
LAPST020531183500000X
AZS020593183500000X
MAPH233629183500000X
TN0000038403183500000X
TX59721183500000X
MI5302043440183500000X
KY018421183500000X
NHR2515183500000X
NY061955183500000X
WVRP0009365183500000X
CTPCT0011999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT0011999OtherPHAMACY LICENSE CT
MAPH233629OtherPHAMACY LICENSE MA