Provider Demographics
NPI:1477530699
Name:SEVERINO, JOSEPH J (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:SEVERINO
Suffix:
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 1:380 HITCHCOCK RD
Mailing Address - Street 2:UNIT 60
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3965
Mailing Address - Country:US
Mailing Address - Phone:203-757-5353
Mailing Address - Fax:
Practice Address - Street 1:50 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5654
Practice Address - Country:US
Practice Address - Phone:203-688-9675
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist