Provider Demographics
NPI:1518398601
Name:PULAWSKI, ELLEN
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:PULAWSKI
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 1:350 NEW SWEDEN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-3218
Mailing Address - Country:US
Mailing Address - Phone:860-974-9122
Mailing Address - Fax:
Practice Address - Street 1:350 NEW SWEDEN RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-3218
Practice Address - Country:US
Practice Address - Phone:860-974-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24002183500000X
CTPCT.0010471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist