Provider Demographics
NPI:1508145525
Name:KRISTOLLARI, VILJAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VILJAN
Middle Name:
Last Name:KRISTOLLARI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 RICHMOND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-4402
Mailing Address - Country:US
Mailing Address - Phone:203-510-2122
Mailing Address - Fax:
Practice Address - Street 1:141 MERIDEN RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1937
Practice Address - Country:US
Practice Address - Phone:203-573-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.0012050OtherPHARMACIST LICENSE