Provider Demographics
NPI:1437202827
Name:SANTELLA, PAT J (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAT
Middle Name:J
Last Name:SANTELLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:PAT
Other - Middle Name:J
Other - Last Name:SANTELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:19 BLACKBERRY RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3981
Mailing Address - Country:US
Mailing Address - Phone:203-452-0865
Mailing Address - Fax:
Practice Address - Street 1:2035 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3550
Practice Address - Country:US
Practice Address - Phone:203-368-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist