Provider Demographics
NPI:1467939504
Name:BREITSPRECHER, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BREITSPRECHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 KITTS LN
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4250
Mailing Address - Country:US
Mailing Address - Phone:860-594-7123
Mailing Address - Fax:
Practice Address - Street 1:206 KITTS LN
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4250
Practice Address - Country:US
Practice Address - Phone:860-594-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist