Provider Demographics
NPI:1528578127
Name:HULTEN, MAEGEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAEGEN
Middle Name:
Last Name:HULTEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6064
Mailing Address - Country:US
Mailing Address - Phone:203-238-0910
Mailing Address - Fax:
Practice Address - Street 1:825 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6064
Practice Address - Country:US
Practice Address - Phone:203-238-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013805183500000X
CT0013805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist